A pilot randomized controlled trial comparing computer-assisted cognitive rehabilitation, stimulant medication, and an active control in the treatment of ADHD

Background This research aimed to compare computer‐assisted cognitive rehabilitation (CACR) psychostimulants (MED) and placebo CACR (PCACR) in the treatment of ADHD using a multiarm parallel design. Methods Thirty‐four boys with ADHD, aged 7–12, were randomly assigned to either CACR (n = 12), MED (n...

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Published in	Child and adolescent mental health Vol. 21; no. 4; pp. 217 - 224
Main Authors	Azami, Saeed, Moghadas, Alireza, Sohrabi-Esmrood, Faramarz, Nazifi, Morteza, Mirmohamad, Mahdieh, Hemmati, Fatemeh, Ahmadi, Ameneh, Hamzeh-poor, Pariya, Khari, Saeedeh, Lakes, Kimberley
Format	Journal Article
Language	English
Published	London Blackwell Publishing Ltd 01.11.2016 Wiley Subscription Services, Inc
Subjects	ADHD cognitive training pharmacotherapy RCT design
Online Access	Get full text
ISSN	1475-357X 1475-3588
DOI	10.1111/camh.12157

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Abstract	Background This research aimed to compare computer‐assisted cognitive rehabilitation (CACR) psychostimulants (MED) and placebo CACR (PCACR) in the treatment of ADHD using a multiarm parallel design. Methods Thirty‐four boys with ADHD, aged 7–12, were randomly assigned to either CACR (n = 12), MED (n = 11), or PCACR (n = 11). However, the study was not blinded and medication doses might be suboptimal given the lack of titration. Continuous performance test, Tower‐of‐London, forward/backward digit span, span board, Raven's progressive matrices, and SNAP‐IV were completed at baseline, posttest, and follow‐up. Results Computer‐assisted cognitive rehabilitation outperformed both MED and PCACR on backward digit span at posttest and PCACR at follow‐up. CACR outperformed PCACR and MED on forward digit span at posttest and PCACR at follow‐up. CACR outperformed MED on span board at posttest. CACR outperformed PCACR and MED on Raven's matrices at posttest. CACR and PCACR scored lower than MED on ADHD‐PHI at posttest. CACR scored lower than MED on ADHD‐C at posttest. Conclusions Immediately after interventions, CACR improved certain simple executive functions (EFs) as much as active stimulant medication. On complex EFs, CACR was superior to active stimulant medication and PCACR. CACR reduced behavioral symptoms of ADHD more than active stimulant medication. However, at 3‐month follow‐up, maintenance of the CACR gains was weak.
AbstractList	Background This research aimed to compare computer‐assisted cognitive rehabilitation (CACR) psychostimulants (MED) and placebo CACR (PCACR) in the treatment of ADHD using a multiarm parallel design. Methods Thirty‐four boys with ADHD, aged 7–12, were randomly assigned to either CACR (n = 12), MED (n = 11), or PCACR (n = 11). However, the study was not blinded and medication doses might be suboptimal given the lack of titration. Continuous performance test, Tower‐of‐London, forward/backward digit span, span board, Raven's progressive matrices, and SNAP‐IV were completed at baseline, posttest, and follow‐up. Results Computer‐assisted cognitive rehabilitation outperformed both MED and PCACR on backward digit span at posttest and PCACR at follow‐up. CACR outperformed PCACR and MED on forward digit span at posttest and PCACR at follow‐up. CACR outperformed MED on span board at posttest. CACR outperformed PCACR and MED on Raven's matrices at posttest. CACR and PCACR scored lower than MED on ADHD‐PHI at posttest. CACR scored lower than MED on ADHD‐C at posttest. Conclusions Immediately after interventions, CACR improved certain simple executive functions (EFs) as much as active stimulant medication. On complex EFs, CACR was superior to active stimulant medication and PCACR. CACR reduced behavioral symptoms of ADHD more than active stimulant medication. However, at 3‐month follow‐up, maintenance of the CACR gains was weak. Background This research aimed to compare computer-assisted cognitive rehabilitation (CACR) psychostimulants (MED) and placebo CACR (PCACR) in the treatment of ADHD using a multiarm parallel design. Methods Thirty-four boys with ADHD, aged 7-12, were randomly assigned to either CACR (n = 12), MED (n = 11), or PCACR (n = 11). However, the study was not blinded and medication doses might be suboptimal given the lack of titration. Continuous performance test, Tower-of-London, forward/backward digit span, span board, Raven's progressive matrices, and SNAP-IV were completed at baseline, posttest, and follow-up. Results Computer-assisted cognitive rehabilitation outperformed both MED and PCACR on backward digit span at posttest and PCACR at follow-up. CACR outperformed PCACR and MED on forward digit span at posttest and PCACR at follow-up. CACR outperformed MED on span board at posttest. CACR outperformed PCACR and MED on Raven's matrices at posttest. CACR and PCACR scored lower than MED on ADHD-PHI at posttest. CACR scored lower than MED on ADHD-C at posttest. Conclusions Immediately after interventions, CACR improved certain simple executive functions (EFs) as much as active stimulant medication. On complex EFs, CACR was superior to active stimulant medication and PCACR. CACR reduced behavioral symptoms of ADHD more than active stimulant medication. However, at 3-month follow-up, maintenance of the CACR gains was weak. This research aimed to compare computer-assisted cognitive rehabilitation (CACR) psychostimulants (MED) and placebo CACR (PCACR) in the treatment of ADHD using a multiarm parallel design.BACKGROUNDThis research aimed to compare computer-assisted cognitive rehabilitation (CACR) psychostimulants (MED) and placebo CACR (PCACR) in the treatment of ADHD using a multiarm parallel design.Thirty-four boys with ADHD, aged 7-12, were randomly assigned to either CACR (n = 12), MED (n = 11), or PCACR (n = 11). However, the study was not blinded and medication doses might be suboptimal given the lack of titration. Continuous performance test, Tower-of-London, forward/backward digit span, span board, Raven's progressive matrices, and SNAP-IV were completed at baseline, posttest, and follow-up.METHODSThirty-four boys with ADHD, aged 7-12, were randomly assigned to either CACR (n = 12), MED (n = 11), or PCACR (n = 11). However, the study was not blinded and medication doses might be suboptimal given the lack of titration. Continuous performance test, Tower-of-London, forward/backward digit span, span board, Raven's progressive matrices, and SNAP-IV were completed at baseline, posttest, and follow-up.Computer-assisted cognitive rehabilitation outperformed both MED and PCACR on backward digit span at posttest and PCACR at follow-up. CACR outperformed PCACR and MED on forward digit span at posttest and PCACR at follow-up. CACR outperformed MED on span board at posttest. CACR outperformed PCACR and MED on Raven's matrices at posttest. CACR and PCACR scored lower than MED on ADHD-PHI at posttest. CACR scored lower than MED on ADHD-C at posttest.RESULTSComputer-assisted cognitive rehabilitation outperformed both MED and PCACR on backward digit span at posttest and PCACR at follow-up. CACR outperformed PCACR and MED on forward digit span at posttest and PCACR at follow-up. CACR outperformed MED on span board at posttest. CACR outperformed PCACR and MED on Raven's matrices at posttest. CACR and PCACR scored lower than MED on ADHD-PHI at posttest. CACR scored lower than MED on ADHD-C at posttest.Immediately after interventions, CACR improved certain simple executive functions (EFs) as much as active stimulant medication. On complex EFs, CACR was superior to active stimulant medication and PCACR. CACR reduced behavioral symptoms of ADHD more than active stimulant medication. However, at 3-month follow-up, maintenance of the CACR gains was weak.CONCLUSIONSImmediately after interventions, CACR improved certain simple executive functions (EFs) as much as active stimulant medication. On complex EFs, CACR was superior to active stimulant medication and PCACR. CACR reduced behavioral symptoms of ADHD more than active stimulant medication. However, at 3-month follow-up, maintenance of the CACR gains was weak.
Author	Nazifi, Morteza Hamzeh-poor, Pariya Ahmadi, Ameneh Moghadas, Alireza Hemmati, Fatemeh Sohrabi-Esmrood, Faramarz Mirmohamad, Mahdieh Khari, Saeedeh Lakes, Kimberley Azami, Saeed
Author_xml	– sequence: 1 givenname: Saeed surname: Azami fullname: Azami, Saeed organization: Department of Clinical and General Psychology, Allameh Tabatabai University, Tehran, Iran – sequence: 2 givenname: Alireza surname: Moghadas fullname: Moghadas, Alireza organization: Department of Clinical and General Psychology, Allameh Tabatabai University, Tehran, Iran – sequence: 3 givenname: Faramarz surname: Sohrabi-Esmrood fullname: Sohrabi-Esmrood, Faramarz organization: Department of Clinical and General Psychology, Allameh Tabatabai University, Tehran, Iran – sequence: 4 givenname: Morteza surname: Nazifi fullname: Nazifi, Morteza email: Nazifi90@yahoo.com organization: Department of Psychology, University of Bojnord, 9453155111, Bojnord, Iran – sequence: 5 givenname: Mahdieh surname: Mirmohamad fullname: Mirmohamad, Mahdieh organization: Institute for Brain and Cognitive Sciences, Shahid-Beheshti University, Tehran, Iran – sequence: 6 givenname: Fatemeh surname: Hemmati fullname: Hemmati, Fatemeh organization: Department of Psychology, Tarbiat Modares University, Tehran, Iran – sequence: 7 givenname: Ameneh surname: Ahmadi fullname: Ahmadi, Ameneh organization: Department of Clinical and General Psychology, Allameh Tabatabai University, Tehran, Iran – sequence: 8 givenname: Pariya surname: Hamzeh-poor fullname: Hamzeh-poor, Pariya organization: Department of Clinical and General Psychology, Allameh Tabatabai University, Tehran, Iran – sequence: 9 givenname: Saeedeh surname: Khari fullname: Khari, Saeedeh organization: Al-Zahra University, Tehran, Iran – sequence: 10 givenname: Kimberley surname: Lakes fullname: Lakes, Kimberley organization: Department of Pediatrics, University of California, CA, Irvine, USA
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References_xml	– reference: Swanson, J., Baler, R.D., & Volkow, N.D. (2010). Understanding the effects of stimulant medications on cognition in individuals with attention-deficit hyperactivity disorder: A decade of progress. Neuropsychopharmacology, 36, 207-226. – reference: Beck, S.J., Hanson, C.A., Puffenberger, S.S., Benninger, K.L., & Benninger, W.B. (2010). A controlled trial of working memory training for children and adolescents with ADHD. Journal of Clinical Child and Adolescent Psychology, 39, 825-836. – reference: Sonuga-Barke, E.J., Brandeis, D., Cortese, S., Daley, D., Ferrin, M., Holtmann, M., ... & Sergeant, J. (2013). Nonpharmacological interventions for ADHD: Systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. American Journal of Psychiatry, 170, 275-289. – reference: Wechsler, D. (1974). Manual for the Wechsler intelligence scale for children, revised. New York: Psychological Corporation. – reference: Alderson, R.M., Rapport, M.D., Kasper, L.J., Sarver, D.E., & Kofler, M.J. (2012). Hyperactivity in boys with attention deficit/hyperactivity disorder (ADHD): The association between deficient behavioral inhibition, attentional processes, and objectively measured activity. Child Neuropsychology, 18, 487-505. – reference: Lumos-Labs. (2012). Brain games & brain training - Lumosity. San Francisco: Author. – reference: Johnstone, S.J., Roodenrys, S., Blackman, R., Johnstone, E., Loveday, K., Mantz, S., & Barratt, M.F. (2012). Neurocognitive training for children with and without AD/HD. Attention Deficit and Hyperactivity Disorders, 4, 11-23. – reference: Raven, J.C., Raven, J., & Court, J. (1962). Coloured progressive matrices. London: HK Lewis. – reference: Cortese, S., Ferrin, M., Brandeis, D., Buitelaar, J., Daley, D., Dittmann, R.W., ... & Sonuga-Barke, E.J.S. (2015). Cognitive training for attention-deficit/hyperactivity disorder: Meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. Journal of the American Academy of Child and Adolescent Psychiatry, 54, 164-174. – reference: Kray, J., Karbach, J., Haenig, S., & Freitag, C. (2011). Can task-switching training enhance executive control functioning in children with attention deficit/-hyperactivity disorder? Frontiers in Human Neuroscience, 5, 180. – reference: Pliszka, S.R. (2007). Pharmacologic treatment of attention-deficit/hyperactivity disorder: Efficacy, safety and mechanisms of action. Neuropsychology Review, 17, 61-72. – reference: Klingberg, T., Fernell, E., Olesen, P.J., Johnson, M., Gustafsson, P., Dahlstrom, K., ... & Westerberg, H. (2005). Computerized training of working memory in children with ADHD - A randomized, controlled trial. 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What are the cognitive effects of stimulant medications? Emphasis on adults with attention-deficit/hyperactivity disorder (ADHD). Neuroscience and Biobehavioral Reviews, 34, 1256-1266. – reference: Swanson, J., Schuck, S., Mann-Porter, M., Carlson, C., Hartman, C., Sergeant, J., ... & Wigal, T. (2012). Categorical and dimensional definitions and evaluations of symptoms of ADHD: History of the SNAP and the SWAN rating scales. The International Journal of Educational and Psychological Assessment, 10, 51-70. – volume: 10 start-page: 51 year: 2012 end-page: 70 article-title: Categorical and dimensional definitions and evaluations of symptoms of ADHD: History of the SNAP and the SWAN rating scales publication-title: The International Journal of Educational and Psychological Assessment – volume: 34 start-page: 1256 year: 2010 end-page: 1266 article-title: What are the cognitive effects of stimulant medications? 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Snippet	Background This research aimed to compare computer‐assisted cognitive rehabilitation (CACR) psychostimulants (MED) and placebo CACR (PCACR) in the treatment of... Background This research aimed to compare computer-assisted cognitive rehabilitation (CACR) psychostimulants (MED) and placebo CACR (PCACR) in the treatment of... This research aimed to compare computer-assisted cognitive rehabilitation (CACR) psychostimulants (MED) and placebo CACR (PCACR) in the treatment of ADHD using...
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SubjectTerms	ADHD cognitive training pharmacotherapy RCT design
Title	A pilot randomized controlled trial comparing computer-assisted cognitive rehabilitation, stimulant medication, and an active control in the treatment of ADHD
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