Published in the Journal of Attention Disorders /April 22, 2014
The Efficacy of Computerized Cognitive Training in Adults with ADHD: A Randomized Controlled Trial
1School of Occupational Therapy, Hadassah and Hebrew University of Jerusalem, Israel
2Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel
3Shaare Zedek Medical Center, Jerusalem, Israel
4Hebrew University of Jerusalem, Israel
A double-blind, randomized controlled trial was conducted in the Occupational Therapy School (Hebrew University, Jerusalem) in cooperation with the department of Adult Psychiatry (Hadassah Hospital, Jerusalem). The trial examined the effectiveness of web-based cognitive training intervention using the AttenFocusTM program by AttenGoTM Cognitive Systems. Participants were adults over 18 years old, diagnosed with ADHD. Measurements included symptom severity, executive functions, and quality of life (AAQoL).
Attention Deficit Hyperactivity Disorder (ADHD) is presently understood by both health professionals and therapists as a developmental disorder with an underlying dysfunction in executive functions (EF). EFs are a collection of high-level cognitive abilities that coordinate and supervise lower level abilities. Executive functions enable goal-driven behavior, including organization, decision making, working memory, planning, self-regulation, prioritizing, effort conservation, motivation, and more.
Because of the dysfunction in EF, over time children and adults with ADHD must cope with difficulties in all areas of their lives: in school, at work, as well as in social and family relationships. Studies show that adults with ADHD are at greater risk for dropping out of school, falling into a lower socio-economic status, unsteady employment, problematic relationships, and more, all of which have a negative effect on quality of life.
Participating in the study were 60 adults diagnosed with ADHD, who were tested before and after the intervention, using the following evaluation tools: questionnaires on ADHD symptoms (ASRS, WURS), executive functions (BRIEF-A), quality of life (AAQoL), a semi-structured interview on everyday functioning (COPM), and a neuro-psychological evaluation (IntegNeuro™ battery).
Participants were randomly divided into two groups: the research group (n=34) and the control group (n=26). The research group trained with the AttenFocusTM training unit. Participants in the control group trained with a dummy program based on AttenFocusTM but with simple and monotonous attention tasks. Participants in both groups were asked to train in their respective programs 4-5 times per week, approximately 25 minutes each time, for a total of three months. At the end of the training period, the evaluation was conducted again using the same tools.
Results and Conclusions
Based on participants’ self-report on symptoms and executive functions, participants in both groups showed significant positive changes in the symptoms of ADHD (WURS, ASRS). Changes were recorded also on questionnaires on executive EFs (BRIEF-A).
Based on the neuro-psychological evaluation (IntegNeuro™), participants showed significant improvements in the sustained attention component, but no significant improvement was found in other EFs.
Participants reported improvement in their daily functioning in common tasks that required EFs. The transfer of gains from cognitive training to daily function is of central importance for the research of intervention tools of this type.
We hypothesize that the difference between results obtained from the self-report questionnaires and the neuro-psychological evaluation is the result of the fact that the EF and AAQoL questionnaires include questions on a wide variety of functional aspects, such as organization, decision making, prioritizing, time management, planning, working memory, and response inhibition, whereas the IntegNeuro™ evaluation examines isolated components such as working memory, response inhibition, and planning.
In addition to specific exercising of cognitive abilities, training programs such as AttenGoTM may have a potential for reflective learning. In other words, the trainees become more aware of their difficulties and consequently better able to manage in social and other situations.
Conclusions from the study, together with a previous pilot study conducted in this field, indicate that there is potential for intervention with this type of computerized cognitive training, which may enable improvements in cognitive skills affected by ADHD. The study also points to a need for further research in this expanding field.
Adi Stern, MSc, OTR, School of Occupational Therapy, Hadassah and Hebrew University of Jerusalem, P.O. Box 24026, Mount Scopus, Jerusalem, Israel, 91240.