Effects of computerized cognitive training as add-on treatment to stimulants in ADHD: a pilot fMRI study

Abstract

The neurofunctional effects of Cognitive training (CT) are poorly understood. Our main objective was to assess fMRI brain activation patterns in children with ADHD who received CT as an add-on treatment to stimulant medication. We included twenty children with ADHD from a clinical trial of stimulant medication and CT (10 in medication + CT and 10 in medication + non-active training). Between-group differences were assessed in performance and in brain activation during 3 fMRI paradigms of working memory (N-back: 0-back, 1-back, 2-back, 3-back), sustained attention (Sustained Attention Task -SAT: 2 s, 5 s and 8 s delays) and inhibitory control (Go/No-Go). We found significant group x time x condition interactions in working memory (WM) and sustained attention on brain activation. In N-back, decreases were observed in the BOLD signal change from baseline to endpoint with increasing WM load in the right insula, right putamen, left thalamus and left pallidum in the CT compared to the non-active group; in SAT -increases in the BOLD signal change from baseline to endpoint with increasing delays were observed in bilateral precuneus, right insula, bilateral associative visual cortex and angular gyrus, right middle temporal, precentral, postcentral, superior frontal and middle frontal gyri in the CT compared to the non-active group. CT in ADHD was associated with changes in activation in task-relevant parietal and striato-limbic regions of sustained attention and working memory. Changes in brain activity may precede behavioral performance modifications in working memory and sustained attention, but not in inhibitory control.

Scaffolding the Attention-Deficit/Hyperactivity Disorder Brain Using Random Noise Stimulation

“…https://doi.org/10.1101/19005983 doi: medRxiv preprint likelihood of contextualization (which is often the result of extensive training using a single task) and increases the likelihood of transfer (Perlman et al, 2016). While the present cognitive training has been used in previous studies that aimed to improve academic performance in typically developing children (Wexler et al, 2016), and in some preliminary studies in children with ADHD (de Oliveira Rosa et al, 2019), the outcome measures in previous studies never included ADHD-RS, which prevented us from estimating the effect size expected from such training alone. As our study focused on comparing the efficacy of two tES methods, rather than on EF training per se, a detailed description of the EF training protocol is beyond the scope of this paper, but can be found elsewhere (see (Wexler et al, 2016)) and the supplementary information section.…”

Review of the Neural Processes of Working Memory Training: Controlling the Impulse to Throw the Baby Out With the Bathwater

“…It was found that training improved working memory accuracy and response times associated with better neural efficiency (reduced activation) that persisted 5 weeks after training in frontal superior/middle cortex, inferior parietal cortex, anterior cingulate cortex, and middle temporal cortex. In another recent fMRI study, WMT with n-back levels 0–3 back was examined as an adjunct to stimulant medication for ADHD, compared to a non-active training group ( 46 ). The authors reported decreased neural activation as working memory load increased and when comparing baseline to end of treatment (48 sessions of 30 min), in the right insula, right putamen, left thalamus, and left pallidum, and increased activation in similar regions after a comparative sustained attention task.…”

“…The majority of fMRI studies have reported decreased activation following WMT ( 40 – 43 , 46 , 54 , 56 – 58 , 60 , 63 ). Garavan and colleagues examined neural responses after WMT in five healthy participants using a delayed match-to-sample task and reported that reduced activation appears to be a consequence of practice effects.…”

“…Furthermore, various psychiatric populations undergoing treatment or at risk of developing a psychiatric disorder demonstrate neurocognitive changes prior to significant behavioral or physical changes, which would support the notion that WMT may alter neurocognitive processes before behavioral far-transfer becomes apparent. In this vein, a recent WMT fMRI study of ADHD suggests that brain changes occur before significant behavioral changes ( 46 ).…”

Updates in technology-based interventions for attention deficit hyperactivity disorder

“…Earlier studies have shown that cognitive training results in increased activation in related brain regions [ 51 , 52 ]. In their functional MRI study of children with ADHD, de Oliveira Rosa et al [ 53 ▪ ] found that those who received cognitive training and stimulant medication showed greater activation of the right fronto-parietal brain areas that mediate sustained attention after intervention, compared with those who received nonactive computerized intervention with stimulant medication. This added further evidence that cognitive training could normalize neural circuits in children with ADHD.…”