Cognitive training for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials

Samuele Cortese; Maite Ferrin; Daniel Brandeis; Jan Buitelaar; David Daley; Ralf W Dittmann; Martin Holtmann; Paramala Santosh; Jim Stevenson; Argyris Stringaris; Alessandro Zuddas; Edmund J S Sonuga-Barke; European ADHD Guidelines Group (EAGG)

doi:10.1016/j.jaac.2014.12.010

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 Mar;54(3):164-74. doi: 10.1016/j.jaac.2014.12.010. Epub 2014 Dec 29.

Collaborators

European ADHD Guidelines Group (EAGG):
T Banaschewski, D Brandeis, J Buitelaar, D Coghill, S Cortese, D Daley, M Danckaerts, R W Dittmann, M Dopfner, M Ferrin, C Hollis, M Holtmann, E Konofal, M Lecendreux, A Rothenberger, P Santosh, J A Sergeant, E Simonoff, E J Sonuga-Barke, C Soutullo, H-Ch Steinhausen, J Stevenson, A Stringaris, E Taylor, S van der Oord, I Wong, A Zuddas

Affiliations

¹ Developmental Brain-Behaviour Laboratory, University of Southampton, UK; School of Medicine, University of Nottingham, UK; New York University Child Study Center, New York.
² King's College London, Institute of Psychiatry, UK; Centro de Salud Mental de Estella, Navarra, Spain; Huntercombe Hospital Maidenhead, UK.
³ Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany; University of Zurich, Switzerland.
⁴ Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands; Karakter Child and Adolescent Psychiatry University Centre, Nijmegen.
⁵ School of Medicine, University of Nottingham, UK; School of Medicine, University of Nottingham, UK and the Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, UK.
⁶ Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany.
⁷ LWL-University Hospital for Child and Adolescent Psychiatry, Ruhr University, Bochum, Germany.
⁸ King's College London, Institute of Psychiatry, UK.
⁹ Developmental Brain-Behaviour Laboratory, University of Southampton, UK.
¹⁰ Unit of Child Neuropsychiatry, University of Cagliari, Cagliari, Italy.
¹¹ Developmental Brain-Behaviour Laboratory, University of Southampton, UK; Ghent University, Belgium; Aarhus University, Denmark. Electronic address: ejb3@soton.ac.uk.

Abstract

Objective: The authors performed meta-analyses of randomized controlled trials to examine the effects of cognitive training on attention-deficit/hyperactivity disorder (ADHD) symptoms, neuropsychological deficits, and academic skills in children/adolescents with ADHD.

Method: The authors searched Pubmed, Ovid, Web of Science, ERIC, and CINAHAL databases through May 18, 2014. Data were aggregated using random-effects models. Studies were evaluated with the Cochrane risk of bias tool.

Results: Sixteen of 695 nonduplicate records were analyzed (759 children with ADHD). When all types of training were considered together, there were significant effects on total ADHD (standardized mean difference [SMD] = 0.37, 95% CI = 0.09-0.66) and inattentive symptoms (SMD = 0.47, 95% CI = 0.14-0.80) for reports by raters most proximal to the treatment setting (i.e., typically unblinded). These figures decreased substantially when the outcomes were provided by probably blinded raters (ADHD total: SMD = 0.20, 95% CI = 0.01-0.40; inattention: SMD = 0.32, 95% CI = -0.01 to 0.66). Effects on hyperactivity/impulsivity symptoms were not significant. There were significant effects on laboratory tests of working memory (verbal: SMD = 0.52, 95% CI = 0.24-0.80; visual: SMD = 0.47, 95% CI = 0.23-0.70) and parent ratings of executive function (SMD = 0.35, 95% CI = 0.08-0.61). Effects on academic performance were not statistically significant. There were no effects of working memory training, specifically on ADHD symptoms. Interventions targeting multiple neuropsychological deficits had large effects on ADHD symptoms rated by most proximal assessors (SMD = 0.79, 95% CI = 0.46-1.12).

Conclusion: Despite improving working memory performance, cognitive training had limited effects on ADHD symptoms according to assessments based on blinded measures. Approaches targeting multiple neuropsychological processes may optimize the transfer of effects from cognitive deficits to clinical symptoms.

Keywords: ADHD; evidence-based psychiatry; executive functions; nonpharmacological; working memory.

Publication types

Meta-Analysis
Review

MeSH terms

Adolescent
Attention Deficit Disorder with Hyperactivity / therapy*
Child
Cognition
Cognitive Behavioral Therapy / methods*
Evidence-Based Practice
Executive Function*
Humans
Memory, Short-Term*
Publication Bias
Randomized Controlled Trials as Topic
Treatment Outcome