Computerized cognitive training and evidence-based practice in pediatric psychology.

Abstract

Objective: Cognitive dysfunction is associated with common pediatric conditions, including attention-deficit/hyperactivity disorder, traumatic brain injury, and acquired brain injuries secondary to acute and chronic illness. There is substantial interest in computerized cognitive training (CCT) as a way to remediate these deficits, but use of CCT has been the subject of ongoing debate regarding its effectiveness. This invited commentary describes the current evidence base and potential benefits and costs of CCT, discusses clinical decision-making from the perspective of evidence-based practice, and offers suggestions for future development and research. Method: A selective review of reviews of the recent CCT literature, with a focus on pediatric conditions. Results: Large claims have been made for the effectiveness of CCT, but research to date indicates only limited and circumscribed benefits. Improvements have been demonstrated in trained tasks and closely related skills, but generalization to other cognitive domains has not convincingly been shown. On the other hand, unequivocally beneficial treatment alternatives are lacking or have their own limitations. This state of affairs raises practical and ethical concerns for clinicians interested in using this intervention. CCT does show promise: It can be delivered at home, potentially increasing access to care, and may be improved by coaching or as an adjunct to other treatments. Conclusions: CCT may provide limited benefits for some pediatric patients, but further research and development is needed before it can considered an effective intervention for cognitive dysfunction. Clinicians considering its use should be sure that patients and families are well informed about its benefits and limitations. Implications for Impact StatementComputerized cognitive training (CCT) is increasingly being promoted as a way to remediate cognitive dysfunction in pediatric patients. This article describes the current evidence-base for CCT, discusses clinical decision-making from the perspective of evidence-based practice in psychology, and offers suggestions for future development and research.