Computerized cognitive training in children and adolescents with attention deficit/hyperactivity disorder as add-on treatment to stimulants: feasibility study and protocol description

• Published in: Trends in psychiatry and psychotherapy 2017-04, Vol.39 (2), p.65-76
• Main Authors: Rosa, Virginia de Oliveira, Schmitz, Marcelo, Moreira-Maia, Carlos Roberto, Wagner, Flavia, Londero, Igor, Bassotto, Caroline de Fraga, Moritz, Guilherme, de Souza, Caroline Dos Santos, Rohde, Luis Augusto Paim
• Format: Article
• Language: English
• Subjects: Adolescents; Attention Deficit Disorder with Hyperactivity - diagnostic imaging; Attention Deficit Disorder with Hyperactivity - physiopathology; Attention Deficit Disorder with Hyperactivity - psychology; Attention Deficit Disorder with Hyperactivity - therapy; Attention deficit hyperactivity disorder; Brain - diagnostic imaging; Brain - physiopathology; Central Nervous System Stimulants - therapeutic use; Child; Children; Children & youth; Clinical Protocols; Clinical trials; Cognition & reasoning; Cognitive ability; Cognitive Remediation - methods; Combined Modality Therapy; Comorbidity; Feasibility Studies; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Neuropsychological Tests; Patient Selection; Pilot Projects; PSYCHIATRY; Psychotropic Drugs - therapeutic use; Single-Blind Method; Stimulants; Teenagers; Therapy, Computer-Assisted; Transtorno de déficit de atenção/hiperatividade (TDAH); tratamento; Treatment Outcome; treinamento cognitivo
• ISSN: 2238-0019; 2238-0019
• DOI: 10.1590/2237-6089-2016-0039

Cognitive training has received increasing attention as a non-pharmacological approach for the treatment of attention deficit/hyperactivity disorder (ADHD) in children and adolescents. Few studies have assessed cognitive training as add-on treatment to medication in randomized placebo controlled trials. The purpose of this preliminary study was to explore the feasibility of implementing a computerized cognitive training program for ADHD in our environment, describe its main characteristics and potential efficacy in a small pilot study. Six ADHD patients aged 10-12-years old receiving stimulants and presenting residual symptoms were enrolled in a randomized clinical trial to either a standard cognitive training program or a controlled placebo condition for 12 weeks. The primary outcome was core ADHD symptoms measured using the Swanson, Nolan and Pelham Questionnaire (SNAP-IV scale). We faced higher resistance than expected to patient enrollment due to logistic issues to attend face-to-face sessions in the hospital and to fill the requirement of medication status and absence of some comorbidities. Both groups showed decrease in parent reported ADHD symptoms without statistical difference between them. In addition, improvements on neuropsychological tests were observed in both groups - mainly on trained tasks. This protocol revealed the need for new strategies to better assess the effectiveness of cognitive training such as the need to implement the intervention in a school environment to have an assessment with more external validity. Given the small sample size of this pilot study, definitive conclusions on the effects of cognitive training as add-on treatment to stimulants would be premature.