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

Cortese, Samuele; Ferrín, Maite; Brandeis, Daniel; Buitelaar, Jan K.; Daley, David; Dittmann, Ralf W.; Holtmann, Martin; Santosh, Paramala; Stevenson, Jim; Stringaris, Argyris; Zuddas, Alessandro; Sonuga‐Barke, Edmund

doi:10.1016/j.jaac.2014.12.010

Cited by 499 publications

(399 citation statements)

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“…EAGG have also recently completed meta-analyses for behavioural interventions and cognitive training using the same core protocol as used here 4,5 . There are striking similarities but also some differences between the results of the present meta-analysis and those from these recent EAGG meta-analyses.…”

Section: Discussionmentioning

confidence: 99%

“…To provide analytical robustness and in line with previous EAGG meta-analyses 4,5,17,20 , analyses of outcome domains were only considered reliable if at least five RCTs were available.…”

Section: Outcome Measuresmentioning

confidence: 99%

“…Where two or more probably blinded ratings were available (which was sometimes the case on sham controlled trials) what was deemed the best probably blinded outcome was selected for analysis, as in Cortese et al 4 . When there were two or more neuropsychological outcome measures, the one most frequently reported across the relevant trials was selected.…”

Section: Data Extraction and Statistical Analysismentioning

confidence: 99%

“…Non-pharmacological interventions -both dietary and psychological -have been also extensively investigated [4][5][6][7] . Among nonpharmacological approaches, neurofeedback has been considered a promising ADHD treatment strategy since the early 1970s [8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

“…Applying the same meta-analyses protocol used in recent EAGG reviews of behavioural interventions 5 and cognitive training 4 , we here extend the focus of meta-analytic evidence relating to neurofeedback for ADHD in a number of ways. First, we included, among the outcomes, not only specific ADHD behavioral dimensions (i.e., inattention and impulsivity/hyperactivity) but also ADHD-related neuropsychological deficits such as inhibitory dysfunction.…”

Section: Introductionmentioning

confidence: 99%

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The European ADHD Guidelines Group replies:

Cortese

Brandeis

Holtmann

et al. 2016

Journal of the American Academy of Child & Adolescent Psych

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Section: Discussionmentioning

confidence: 99%

“…To provide analytical robustness and in line with previous EAGG meta-analyses 4,5,17,20 , analyses of outcome domains were only considered reliable if at least five RCTs were available.…”

Section: Outcome Measuresmentioning

confidence: 99%

Section: Data Extraction and Statistical Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The European ADHD Guidelines Group replies:

Cortese

Brandeis

Holtmann

et al. 2016

Journal of the American Academy of Child & Adolescent Psych

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Academic Outcomes 2 Years After Working Memory Training for Children With Low Working Memory

et al. 2016

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IMPORTANCE Working memory training may help children with attention and learning difficulties, but robust evidence from population-level randomized controlled clinical trials is lacking.OBJECTIVE To test whether a computerized adaptive working memory intervention program improves long-term academic outcomes of children 6 to 7 years of age with low working memory compared with usual classroom teaching. DESIGN, SETTING, AND PARTICIPANTSPopulation-based randomized controlled clinical trial of first graders from 44 schools in Melbourne, Australia, who underwent a verbal and visuospatial working memory screening. Children were classified as having low working memory if their scores were below the 15th percentile on either the Backward Digit Recall or Mister X subtest from the Automated Working Memory Assessment, or if their scores were below the 25th percentile on both. These children were randomly assigned by an independent statistician to either an intervention or a control arm using a concealed computerized random number sequence. Researchers were blinded to group assignment at time of screening. We conducted our trial from March 1, 2012, to February 1, 2015; our final analysis was on October 30, 2015. We used intention-to-treat analyses. INTERVENTION Cogmed working memory training, comprising 20 to 25 training sessions of 45 minutes' duration at school. MAIN OUTCOMES AND MEASURESDirectly assessed (at 12 and 24 months) academic outcomes (reading, math, and spelling scores as primary outcomes) and working memory (also assessed at 6 months); parent-, teacher-, and child-reported behavioral and social-emotional functioning and quality of life; and intervention costs. RESULTSOf 1723 children screened (mean [SD] age, 6.9 [0.4] years), 226 were randomized to each arm (452 total), with 90% retention at 1 year and 88% retention at 2 years; 90.3% of children in the intervention arm completed at least 20 sessions. Of the 4 short-term and working memory outcomes, 1 outcome (visuospatial short-term memory) benefited the children at 6 months (effect size, 0.43 [95% CI, 0.25-0.62]) and 12 months (effect size, 0.49 [95% CI, 0.28-0.70]), but not at 24 months. There were no benefits to any other outcomes; in fact, the math scores of the children in the intervention arm were worse at 2 years (mean difference, −3.0 [95% CI, −5.4 to −0.7]; P = .01). Intervention costs were A$1035 per child. CONCLUSIONS AND RELEVANCEWorking memory screening of children 6 to 7 years of age is feasible, and an adaptive working memory training program may temporarily improve visuospatial short-term memory. Given the loss of classroom time, cost, and lack of lasting benefit, we cannot recommend population-based delivery of Cogmed within a screening paradigm.

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Neurofeedback for Attention-Deficit/Hyperactivity Disorder

Westwood,

Aggensteiner,

Kaiser

et al. 2024

JAMA Psychiatry

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ImportanceNeurofeedback has been proposed for the treatment of attention-deficit/hyperactivity disorder (ADHD) but the efficacy of this intervention remains unclear.ObjectiveTo conduct a meta-analysis of randomized clinical trials (RCTs) using probably blinded (ie, rated by individuals probably or certainly unaware of treatment allocation) or neuropsychological outcomes to test the efficacy of neurofeedback as a treatment for ADHD in terms of core symptom reduction and improved neuropsychological outcomes.Data SourcesPubMed (MEDLINE), Ovid (PsycInfo, MEDLINE, Embase + Embase Classic), and Web of Science, as well as the reference lists of eligible records and relevant systematic reviews, were searched until July 25, 2023, with no language limits.Study SelectionParallel-arm RCTs investigating neurofeedback in participants of any age with a clinical ADHD or hyperkinetic syndrome diagnosis were included.Data Extraction and SynthesisStandardized mean differences (SMDs) with Hedges g correction were pooled in random effects meta-analyses for all eligible outcomes.Main Outcomes and MeasuresThe primary outcome was ADHD total symptom severity assessed at the first postintervention time point, focusing on reports by individuals judged probably or certainly unaware of treatment allocation (probably blinded). Secondary outcomes were inattention and/or hyperactivity-impulsivity symptoms and neuropsychological outcomes postintervention and at a longer-term follow-up (ie, after the last follow-up time point). RCTs were assessed with the Cochrane risk of bias tool version 2.0.ResultsA total of 38 RCTs (2472 participants aged 5 to 40 years) were included. Probably blinded reports of ADHD total symptoms showed no significant improvement with neurofeedback (k = 20; n = 1214; SMD, 0.04; 95% CI, −0.10 to 0.18). A small significant improvement was seen when analyses were restricted to RCTs using established standard protocols (k = 9; n = 681; SMD, 0.21; 95% CI, 0.02 to 0.40). Results remained similar with adults excluded or when analyses were restricted to RCTs where cortical learning or self-regulation was established. Of the 5 neuropsychological outcomes analyzed, a significant but small improvement was observed only for processing speed (k = 15; n = 909; SMD, 0.35; 95% CI, 0.01 to 0.69). Heterogeneity was generally low to moderate.Conclusions and RelevanceOverall, neurofeedback did not appear to meaningfully benefit individuals with ADHD, clinically or neuropsychologically, at the group level. Future studies seeking to identify individuals with ADHD who may benefit from neurofeedback could focus on using standard neurofeedback protocols, measuring processing speed, and leveraging advances in precision medicine, including neuroimaging technology.

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

Cited by 499 publications

References 39 publications

The European ADHD Guidelines Group replies:

The European ADHD Guidelines Group replies:

Academic Outcomes 2 Years After Working Memory Training for Children With Low Working Memory

Neurofeedback for Attention-Deficit/Hyperactivity Disorder

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