期刊
JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY
卷 54, 期 3, 页码 164-174出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jaac.2014.12.010
关键词
ADHD; nonpharmacological; working memory; executive functions; evidence-based psychiatry
资金
- Instituto de Salud Carlos III
- Consejeria de Salud Junta de Andalucia
- Gobierno de Navarra (Beca Jeronimo Ayanz)
- Fundacion Alicia Koplowitz
- Shire
- 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
- Theravance
- AstraZeneca
- Bristol-Myers Squibb
- Medice
- Neuroconn
- Novartis
- EU (FP7 Programme)
- National Institute for Health Research (NIHR)
- Wellcome Trust
- NIHR
- Department of Health UK
- Italian National Institute of Health
- Sardinian Secretary of Public Health
- Vifor
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 CINTAHAL 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.
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