Cognitive Training for Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Clinical and Neuropsychological Outcomes From Randomized Controlled Trials

Samuele Cortese, MD, PhD, Maite Ferrin, MD, PhD, Daniel Brandeis, PhD, Jan Buitelaar, MD, PhD, David Daley, PhD, Ralf W. Dittmann, MD, PhD, Martin Holtmann, MD, Paramala Santosh, MD, PhD, Jim Stevenson, PhD, Argyris Stringaris, MD, PhD, MRCPsych, Alessandro Zuddas, MD, Edmund J.S. Sonuga-Barke, PhD, on behalf of the European ADHD Guidelines Group (EAGG)

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] ¼ 0.37, 95% CI ¼ 0.09–0.66) and inattentive symptoms (SMD ¼ 0.47, 95% CI ¼ 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 ¼ 0.20, 95% CI ¼ 0.01– 0.40; inattention: SMD ¼ 0.32, 95% CI ¼ 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 ¼ 0.52, 95% CI ¼ 0.24–0.80; visual: SMD ¼ 0.47, 95% CI ¼ 0.23–0.70) and parent ratings of executive function (SMD ¼ 0.35, 95% CI ¼ 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 ¼ 0.79, 95% CI ¼ 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 r of effects from cognitive deficits to clinical symptoms.

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