Does ACT-Group Training Improve Cognitive Domain in Children with Attention Deficit Hyperactivity Disorder? A Single-Arm, Open-Label Study

Abstract

This single-arm, open-label study aimed to investigate the efficacy of a cognitive-behavioural group training based on acceptance and commitment therapy (ACT) on cognition in drug-naïve children with attention deficit hyperactivity disorder (ADHD). Thirty-six children with ADHD aged 8–13 were invited to participate in the 9-month ACT training programme, which consisted of 26 weekly sessions of group therapy lasting 90 min each. Their parents also received 12 sessions of ACT-based parent training, every 2 weeks. The outcome measure for the present study was the change in the cognitive performance assessed by a battery of computerised task. The cognitive outcome of children receiving ACT-group intervention was compared to that of an external untreated control group of children with ADHD. No significant improvements were observed in any of the cognitive measures. This preliminary study suggests that the 9-month ACT-group training programme might not have positive effects on cognitive difficulties usually occurring in ADHD. Future randomised controlled trials with larger sample sizes are required to shed more light on this issue.

Acceptance and commitment therapy for individuals having attention deficit hyperactivity disorder (ADHD): A scoping review

“…Additionally, a single-arm, open-label study compared usefulness of ACT-based group child training course across various cognitive domains (i.e., focused, and sustained attention, inhibition, and flexibility) in 29 school-aged individuals with ADHD ( Vanzin et al., 2020 ). However, the findings of this 9-month ACT group training programme, comprising 26 weekly sessions, did not demonstrate a conclusive indication regarding usefulness of ACT-based group child training on cognitive performance of children with ADHD ( Vanzin et al., 2020 ). A similar evaluation was conducted to assess the usefulness of 10-session ACT for ADHD symptoms as well as academic procrastination of 16 adolescents ( Gholipour et al., 2019 ).…”

“…The results also indicated that ACT was used as a treatment modality for individuals with ADHD for a variety of behavioural and psychosocial domains, which included reducing ADHD symptoms (e.g., behaviour, focussed and sustained attention, inflexibility, etc. ; Bayat et al., 2019 ; Gholipour et al., 2019 ; Vanzin et al., 2020 ; Murrell et al., 2015 ; Vanzin et al., 2019 ; Vanzin et al., 2020 ) and other sequelae related to the ADHD diagnosis such as quality of life, academic procrastination, depression and anxiety symptoms, and psychological adjustment ( Bayat et al., 2019 ; Fullen et al., 2020 ; Gholipour et al., 2019 ). This shows that ACT was a flexible approach that could be adapted to deliver both targeted treatment of ADHD symptomatology and more general psychosocial issues, and also that it could be delivered in group or individual formats.…”

“…The effectiveness of ACT was extended to psychosocial and QoL outcomes ( Bayat et al., 2019 ; Fullen et al., 2020 ). One study using group training but failed to record significant improvements in the cognitive domain ( Vanzin et al., 2020 ). Nevertheless, it should be considered that these articles suffered from methodological weaknesses such as using experimental, quasi-experimental, and explorative single-arm open-label study designs and none of them were randomized controlled trials.…”

“… 4 Murrell et al., 2015 USA The feasibility of using acceptance and commitment therapy (ACT) to foster increases in congruence between values and behaviors pertinent to those values quasi-experimental design N = 9 (11–15 years; M = 11.78, SD = 1.30) 5 F, 4 M 9 ____---__ charter school in an urban, South-central area of the United States (school was designed specifically for children with ADHD) Group __--- __--- Avoidance and Fusion Questionnaire for Youth (AFQ-Y) Behavior Assessment System for Children, second edition (BASC-2) comprising: the Teacher Rating Scales (TRS), the Parent Rating Scales (PRS), the structured developmental history (SDH) form, the student observation system (SOS), and the self-report of personality (SRP) The data suggests that acceptance and mindfulness based treatments may be feasible and effective for use with children and adolescents with ADHD, LD's, and comorbid behavior problems. 5 Vanzin et al., 2020 Italy To evaluate the effectiveness of an Acceptance and Commitment Therapy (ACT)-based training protocol, in adjunct to token economy and previous parent training, in a sample of children with Attention-Deficit/Hyperactivity Disorder (ADHD). explorative single-arm open-label study N = 31 (8–13 years; Mage = 10.7 years, SD = 1.4) 2 F, 29 M 31 ___---___ Child Psychopathology Unit of the Institute for ADHD treatment Group 9-month ACT training programme ____ Conners' Parent Rating Scale -Revised: Long version (CPRS-R:L) Clinical Global Impression -Severity (CGI-S) At the end of the ACT protocol, children showed significant improvement in global functioning and behavioural symptoms.…”

“…Symptom severity as rated by CGI-S scores decreased in 74.2% of the children. 6 Vanzin et al., 2020 Italy To investigate the efficacy of a cognitive-behavioural group training based on acceptance and commitment therapy (ACT) on cognition in drug-naïve children with attention deficit hyperactivity disorder (ADHD) explorative single-arm open-label study N = 29 (8–13 years; Mean age = 10.25, SD = 1.35) F 5, M 24 29 25; Mage = 10.91, SD = 1.42 (F2, M23) recruited from the Child Psychopathology Unit Group 9-month ACT training programme; 26 weekly sessions of group therapy lasting 90 min each Amsterdam Neuropsychological Tasks Conners' Parent Rating Scale-R ADHD Rating Scale IV Parent Version — Investigator completed (ADHD-RS) Clinical Global Impression-Severity Scale The cognitive outcome of children receiving ACT-group intervention was compared to that of an external untreated control group of children with ADHD. No significant improvements were observed in any of the cognitive measures.…”