Previous research has focused on the anterior cingulate cortex (ACC) as a key brain region in the mitigation of the competition that arises from two simultaneously active signals. However, to date, no study has demonstrated that ACC is necessary for this form of behavioral flexibility, nor have any studies shown that ACC acts by modulating downstream brain regions such as the dorsal medial striatum (DMS) that encode action plans necessary for task completion. Here, we performed unilateral excitotoxic lesions of ACC while recording downstream from the ipsilateral hemisphere of DMS in rats, performing a variant of the STOP-signal task. We show that on STOP trials lesioned rats perform worse, in part due to the failure of timely directional action plans to emerge in the DMS, as well as the overrepresentation of the to-be-inhibited behavior. Collectively, our findings suggest that ACC is necessary for the mitigation of competing inputs and validates many of the existing theoretical predictions for the role of ACC in cognitive control.

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Objective: Central executive training (CET) is a “Level 2” evidence-based treatment for improving ADHD-related executive dysfunction and behavioral symptoms, but the extent to which these gains extend to the disorder’s well-documented academic difficulties is unknown. Method: Across two clinical trials, 108 children with attention-deficit/hyperactivity disorder (ADHD) 8–13 years old (M = 10.29, SD = 1.50; 32 girls; 75% White/Non-Hispanic) were treated with CET (n = 52), inhibitory control training (ICT; n = 29), or gold-standard behavioral parent training (BPT; n = 27). Results: CET was superior to BPT and ICT (d = 0.62–0.88) for improving masked teacher perceptions of academic success, impulse control, and academic productivity at 1–2 months posttreatment. At 2–4-month follow-up, CET (d = 0.76) and ICT (d = 0.54) were superior to BPT for improving objectively-tested academic achievement overall (reading comprehension, math problem-solving, language comprehension), and CET was superior to ICT (d = 0.56) for improving math problem-solving. The significant benefits of CET on academic success, academic productivity, reading comprehension, and math problem-solving replicated across both trials and were clinically significant as evidenced by low number needed to treat estimates (Needed to Treat; NNT = 3–7) and significantly higher proportions of individual cases demonstrating reliable improvements in academic success/productivity (33%–36% vs. 0%–18%) and achievement (38%–72% vs. 18%–54%) across outcomes (all p ≤ .01). Conclusions: Results across the two trials provide strong support for the efficacy of CET for ADHD, and are consistent with model-driven hypotheses that academic difficulties in ADHD are due, in part, to these children’s underdeveloped executive functioning abilities.

Objective: Utilizing a multi-level meta-analytic approach, this review is the first to systematically quantify the efficacy of reading interventions for school-aged children with ADHD and identify potential factors that may increase the success of reading-related interventions for these children. Method: 18 studies (15 peer-reviewed articles, 3 dissertations) published from 1986 to 2020 ( N = 564) were meta-analyzed. Results: Findings revealed reading interventions are highly effective for improving reading skills based on both study-developed/curriculum-based measures ( g = 1.91) and standardized/norm-referenced achievement tests ( g = 1.11) in high-quality studies of children with rigorously-diagnosed ADHD. Reading interventions that include at least 30 hours of intervention targeting decoding/phonemic awareness meet all benchmarks to be considered a Level 1 (Well-Established) Evidence-Based Practice with Strong Research Support for children with ADHD based on clinical and special education criteria. Conclusions: Our findings collectively indicate that reading interventions should be the first-line treatment for reading difficulties among at-risk readers with ADHD.

Objective: Central executive training (CET) is a ‘level 2’ evidence-based treatment for improvingADHD-related executive dysfunction and behavioral symptoms, but the extent to which these gains extend to the disorder’s well-documented academic difficulties has not been investigated. Method: Across two clinical trials, 108 children with ADHD ages 8-13 (M=10.29, SD=1.50; 32 girls; 75% White/Non-Hispanic) were treated with CET (n=52), inhibitory control training (ICT; n=29), or gold- standard behavioral parent training (n=27). Results: Across trials, CET was superior to both BPT and ICT (d=0.62-0.88) for improving masked teacher perceptions of academic success, impulse control, and academic productivity at 1-2 months post-treatment. CET (d=0.76) and ICT (d=0.54) were both superior to BPT for improving objectively-tested academic achievement overall (reading comprehension, math problem-solving, language comprehension) at 2-4 month follow-up. In terms of specific academic domains, CET was superior to BPT (d=0.71) and ICT (d=0.56) for improving math problem-solving skills and superior to BPT for improving reading comprehension (d=0.64). CET was also associated with significant improvements in language comprehension in Study 1 (d=0.46), but this effect failed to replicate in Study 2; neither BPT nor ICT were associated with changes in language comprehension (d=0.01-0.20). The significant benefits of CET on academic success, academic productivity, reading comprehension, and math problem-solving replicated across the two trials. Conclusions: Results across the two trials reported herein provide strong support for the efficacy of CET for ADHD, and are consistent with model-driven hypotheses that academic difficulties in ADHD are due, in part, to these children’s underdeveloped executive functioning abilities.