Cognitive Training for Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Clinical and Neuropsychological Outcomes From Randomized Controlled Trials - 25/02/15
on behalf of the
European ADHD Guidelines Group (EAGG)
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.
Le texte complet de cet article est disponible en PDF.Key Words : ADHD, nonpharmacological, working memory, executive functions, evidence-based psychiatry
Plan
| Supplemental material cited in this article is available online. |
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| This article can be used to obtain continuing medical education (CME) at www.jaacap.org. |
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| Support for meetings and analyses was received from Brain Products GMBH, Janssen-Cilag, Eli Lilly and Co., Medice, Shire, and Vifor. No honoraria were received, and funders had no input for the review and meta-analysis process or the writing of this article. |
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| The European ADHD Guidelines Group (EAGG) is a workgroup of the European Network for Hyperkinetic Disorder (EUNETHYDIS) and consists of the following members and associates co-opted to work on this review (listed in alphabetical order): T. Banaschewski, MD, PhD; D. Brandeis, PhD; J. Buitelaar, MD, PhD; D. Coghill, MD; S. Cortese, MD, PhD; D. Daley, PhD; M. Danckaerts, MD, PhD; R.W. Dittmann, MD, PhD; M. Döpfner, PhD; M. Ferrin, MD, PhD; C. Hollis, MD, PhD; M. Holtmann, MD, PhD; E. Konofal, MD, PhD; M. Lecendreux, MD; A. Rothenberger, MD; P. Santosh, MD; J.A. Sergeant, PhD; E. Simonoff, MD; E.J. Sonuga-Barke, PhD; C. Soutullo, MD, PhD; H-Ch. Steinhausen, MD, PhD; J. Stevenson, PhD; A. Stringaris, MD, PhD; E. Taylor, MD; S. van der Oord, PhD; I. Wong, PhD; and A. Zuddas, MD. |
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| The authors thank the following individuals for providing additional information on studies and/or advice: Corrado Barbui, MD, PhD, Verona University, Italy; Andrea Cipriani, MD, PhD, Oxford University, UK; Jens Egeland, PhD, Oslo University, Norway; Stuart J. Johnstone, PhD, University of Wollongong, Australia; Marianna Purgato, PhD, Johns Hopkins University, USA; David Rabiner, PhD, Duke University, USA; Lilach Shalev-Mevorah, PhD, Tel-Aviv University, Israel; Leanne Tamm, PhD, Cincinnati Children’s Hospital, USA; Rosemary Tannock, PhD, Hospital for Sick Children, Toronto, Canada; Olivier Tucha, PhD, Groningen University, Netherlands; and Martine van Dongen-Boomsma, MD, Radboud University Nijmegen, Netherlands. |
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| Disclosure: Dr. Cortese has received royalties from Argon Healthcare Italia. Dr. Ferrin has received economic support from the Instituto de Salud Carlos III, Consejeria de Salud Junta de Andalucia, Gobierno de Navarra (Beca Jeronimo Ayanz), and Fundación Alicia Koplowitz. Prof. Buitelaar has served as a consultant to/advisory board member of/ and/or speaker for Janssen Cilag BV, Eli Lilly and Co., and Servier. Prof. Daley has provided educational talks for Eli Lilly and Co. and Shire; has attended an advisory board for Eli Lilly and Co.; has received support for educational travel from Eli Lilly and Co., Shire, and HP Pharma; and has received funding from Shire. Prof. Dittmann has received compensation for serving as a consultant or speaker for, or he or the institution he works for have received research support or royalties from the companies or organizations indicated: the European Union (EU FP7 Programme), US National Institute of Mental Health (NIMH), German Federal Ministry of Health/Regulatory Agency (BMG/BfArM), German Federal Ministry of Education and Research (BMBF), German Research Foundation (DFG), Volkswagen Foundation, Ferring, Janssen-Cilag, Eli Lilly and Co., Otsuka, Shire, and Theravance. He owns Eli Lilly and Co. stock. Prof. Holtmann has served as an advisor or consultant for Eli Lilly and Co., Novartis, Shire, and Bristol-Myers Squibb and has received conference attendance support or was paid for public speaking by AstraZeneca, Bristol-Myers Squibb, Janssen-Cilag, Eli Lilly and Co., Medice, Neuroconn, Novartis, and Shire. Dr. Santosh has received research funding from the EU (FP7 Programme) and the National Institute for Health Research (NIHR). He is also a director and shareholder of HealthTracker, Ltd., UK, and HighStreet Medical Dental, Gillingham, UK. Dr. Stringaris has received grant or research support from the Wellcome Trust, the NIHR, and the Department of Health UK. He has received royalties from Cambridge University Press for his book The Maudsley Reader in Phenomenological Psychiatry. Prof. Zuddas has received research grants from the EU (FP7 Programme), Italian National Institute of Health, Sardinian Secretary of Public Health, Eli Lilly and Co., Shire, and Vifor and has served as speaker, adviser, or consultant for AstraZeneca, Bristol-Myers Squibb, Eli Lilly and Co., Lundbeck, Schering-Plough, Shire, and Vifor. He has been a member of Data Safety Monitoring Boards for Otsuka and Lundbeck. Prof. Sonuga-Barke has served on the speakers’ board of Shire and Janssen-Cilag; has served as a consultant to Shire and NeuroTechnology Solutions, Ltd.; has received research support from Janssen-Cilag and Shire; has served on the advisory board of Shire and NeuroTechnology Solutions, Ltd.; and has received conference support from Shire. Profs. Brandeis and Stevenson report no biomedical financial interests or potential conflicts of interest. |
Vol 54 - N° 3
P. 164-174 - mars 2015 Retour au numéro
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