Attention Networks in ADHD Adults after Working Memory Training with a Dual n-Back Task

Abstract

Patients affected by Attention-Deficit/Hyperactivity Disorder (ADHD) are characterized by impaired executive functioning and/or attention deficits. Our study aim is to determine whether the outcomes measured by the Attention Network Task (ANT), i.e., the reaction times (RTs) to specific target and cue conditions and alerting, orienting, and conflict (or executive control) effects are affected by cognitive training with a Dual n-back task. We considered three groups of young adult participants: ADHD patients without medication (ADHD), ADHD with medication (MADHD), and age/education-matched controls. Working memory training consisted of a daily practice of 20 blocks of Dual n-back task (approximately 30 min per day) for 20 days within one month. Participants of each group were randomly assigned into two subgroups, the first one with an adaptive mode of difficulty (adaptive training), while the second was blocked at the level 1 during the whole training phase (1-back task, baseline training). Alerting and orienting effects were not modified by working memory training. The dimensional analysis showed that after baseline training, the lesser the severity of the hyperactive-impulsive symptoms, the larger the improvement of reaction times on trials with high executive control/conflict demand (i.e., what is called Conflict Effect), irrespective of the participants’ group. In the categorical analysis, we observed the improvement in such Conflict Effect after the adaptive training in adult ADHD patients irrespective of their medication, but not in controls. The ex-Gaussian analysis of RT and RT variability showed that the improvement in the Conflict Effect correlated with a decrease in the proportion of extreme slow responses. The Dual n-back task in the adaptive mode offers as a promising candidate for a cognitive remediation of adult ADHD patients without pharmaceutical medication.

Goal management training improves executive control in adults with ADHD: an open trial employing attention network theory to examine effects on attention

“…The positive change in executive control was detectable immediately after the intervention ended, whereas the change in orienting attention appeared on the follow-up assessment six months later. The current findings showing improvements in executive control following GMT are in line with previous studies showing that this network is malleable to improvement after non-pharmacological interventions in adults with [42] and without ADHD [45]. The findings are also in accordance with earlier investigations of GMT for other disorders showing a reduction in errors on various neuropsychological measures which include an aspect of response ambiguity [24,46].…”

“…The sample size also did not allow for statistical power to perform between-group analyses to explore the influence of factors such as medication status and ADHD-subtype. Earlier findings indicate that these factors may influence RTs on the ANT-R (e.g., [42]) and we found an indication in the current study of a negative relationship between medication use and the flanker effect. Related to this, the fact that analyses were limited to participants who completed two or more assessments may have influenced the finding.…”

“…So far, the use of the attention network theory to examine treatment effects in studies of adults with ADHD is limited. One study by Dotare et al [42] reported positive effects of a computer-based cognitive remediation training program on executive control and not on the alerting or orienting networks. This is in line with findings showing that children without ADHD experienced positive effects of a tailored computer-based training program [43] specifically on the executive control network, and that children with the poorest attentional control at baseline were most likely to benefit from such interventions.…”

A Dissociation of Attention, Executive Function and Reaction to Difficulty: Development of the MindPulse Test, a Novel Digital Neuropsychological Test for Precise Quantification of Perceptual-Motor Decision-Making Processes

“…Variance also concerns pathologies such as schizophrenia where increased reaction time intra-subject variability in fast decision tasks has been confirmed in patients and might be linked to a deficit in the inhibitory control of action ( Panagiotaropoulou et al, 2019 ). From the analysis according to the three parameters of ex-Gaussians, our data are generally comparable with those in the literature ( Swick et al, 2013 ; Dotare et al, 2020 ). Our values of tau are slightly higher, which shows that our test tends to generate extreme RTs, which is recognized as being a good indicator in certain pathologies of attention such as ADHD ( Tarantino et al, 2013 ).…”

When Alcohol Adverts Catch the Eye: A Psychometrically Reliable Dual-Probe Measure of Attentional Bias

“…In the present study, we employed a self-report measure of attentional control, and so the absence of an association between attentional bias and attentional control may reflect the fact that participants' genuine ability to control their attention was not assessed. Thus, we suggest that future researchers who wish to investigate the association between the patterns of attentional selectivity revealed by the current dual-probe approach and attentional control should employ performance-based procedures for assessing attentional control or attentional control training tasks such as the dual n-back task [41,42]. In this way, the association between attentional bias and attentional control could be, respectively, addressed by investigating the naturally occurring association between these two variables, or by determining whether the direct modification of attentional control serves to alter the patterns of attentional selectivity revealed by the dual-probe task.…”