Training Cognition in ADHD: Current Findings, Borrowed Concepts, and Future Directions

Abstract

With both its high prevalence and myriad of negative outcomes, Attention-Deficit/Hyperactivity Disorder (ADHD) demands a careful consideration of the efficacy of its treatment options. Although the benefits of medication have a robust empirical background, nonpharmaceutical interventions evoke particular interest, as they are often viewed more favorably by parents. This review pays special attention to the use of working memory and recent cognitive training attempts in ADHD, describing its cognitive, behavioral, and biological effects in relation to current neurological theory of the disorder. While these treatments have demonstrated positive effects on some measures, there are limitations, as studies have failed to demonstrate generalization to critical measures, such as teacher-rated classroom behaviors, and have provided limited but growing evidence of functionally significant improvements in behavior. There is also a clear lack of research on the effects of training on reward systems and self-control. These limitations may be addressed by broadening the scope and procedures of the training and incorporating research concepts from other fields of study. First, it is important to consider the developmental trajectories of brain regions in individuals with the disorder, as they may relate to the effectiveness of cognitive training. Notions from behavioral economics, including delay discounting and framing (i.e., context) manipulations that influence present orientation, also have applications in the study of cognitive training in ADHD. In considering these other domains, we may find new ways to conceptualize and enhance cognitive training in ADHD and, in turn, address current limitations of interventions that fall in this category.Keywords Attention deficit hyperactivity disorder . Treatment . Working memory training . Nonpharmacological . Delay discounting Need for Improved Treatments in ADHDAttention-deficit/hyperactivity disorder (ADHD) is a critical public health concern, given that it is the most common childhood behavioral disorder, with prevalence rates of at least 5 % [1,2]. ADHD is associated with negative outcomes in academic achievement, including lower reading and math achievement scores [3][4][5][6][7], lower high school completion rates [8] and an alarmingly high use of special education services [9]. Significantly elevated rates of antisocial behavior, increased arrests, and greater substance abuse exist in adolescents and adults with ADHD [9][10][11]. This constellation of negative outcomes underscores the need for additional ADHD treatments.There continues to be a great need to identify more effective and adjunctive interventions for ADHD. This is particularly true, given that current treatments do not appear to have long-term benefits once the intervention has been stopped. Some of the most compelling results on this issue come from the Multimodal Treatment Study of ADHD [12,13], the most comprehensive treatment study of ADHD to date. The study reported initial positive effects of med...

Cognitive Training in Mental Disorders: Update and Future Directions

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“…Early adolescence, characterized by a heightened sensitivity to reward and rapid development of cognitive control systems, may be one such period (38). …”

A Cognitive Framework for Understanding and Improving Interference Resolution in the Brain

“…Thus, continuous performance feedback and adaptive task challenge uniquely customize the training to the cognitive status of each individual. These training principles have been previously applied in successful language learning programs for dyslexic children in over 3.5 million children worldwide by Scientific Learning ® (Hayes et al, 2003; Tallal et al, 1996; Temple et al, 2003), in more than 200,000 elderly adults to ameliorate declining cognitive function in old age by Posit Science ® (Anderson et al, 2013; Ball et al, 2010; Mahncke et al, 2006; Smith et al, 2009; Wolinsky et al, 2013), and in WM training for children with attention deficits developed by CogMed ® (Klingberg, 2010; Rutledge et al, 2012), to name a few. Importantly, however, cognitive training for interference regulation and suppression has not been directly targeted in past efforts.…”

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