Computer-based multiple component cognitive training in children with ADHD: a pilot study

Background: Individuals with obesity are known to present cognitive deficits, especially in executive functions. Executive functions play an important role in health and success throughout the whole life and have been related to food decision-making and to the ability to maintain energy balance. It is possible to improve executive functions through targeted training. This would involve brain plasticity changes that could be studied through connectivity MRI. The general hypothesis of this study is that executive functions training in children with obesity can improve food choices and produce cognitive and neuroimaging changes (structural and functional connectivity), as well as improve emotional state and quality of life.Methods: Randomized controlled double-blind trial with 12-month follow-up. Thirty children with obesity will be randomly allocated into “executive training” (Cognifit with adaptive difficulty + Cogmed) or “control task” group (Cognifit without adaptive difficulty). Both groups will attend 30–45 min of individual gamified training (Cogmed and/or Cognifit systems) by iPad, five times per week during 6 weeks. Cogmed and Cognifit software are commercially available from Pearson and Cognifit, respectively. Participants will receive an iPad with both apps installed for a 6-week use. Participants will also receive counseling diet information via presentations sent to the iPad and will wear a Fitbit Flex 2 tracker to monitor daily activity and sleep patterns. Main outcomes will be cognitive, emotional, food decision, and quality-of-life measures, as well as neuroimaging measures. Participants are evaluated at baseline (T0), after treatment (T1), and 12 months since baseline (T2).Discussion: Longitudinal study with active control group and 3 time points: baseline, immediately after treatment, and 1 year after baseline. Threefold treatment: executive function training, psychoeducation, and feedback on activity/sleep tracking. We will evaluate the transfer effects of the intervention, including emotional and functional outcomes, as well as the effects on neural plasticity by connectivity MRI.Trial registration: This project has been registered in ClinicalTrials.gov (trial registration number NCT03615274), August 3, 2018.

Executive function, which is a set of thinking skills that includes stopping unwanted responses, being flexible, and remembering information needed to solve problems, is a challenge for many children on the autism spectrum. This study tested whether executive function could be improved with a computerized executive function training program under the guidance of a coach who reinforced the use of executive function skills. Seventy children with autism spectrum disorder from age 7 to 11 years of age participated in the study. They were randomly assigned to receive training or to a waiting group. The tests most likely to determine whether the training may be effective were chosen from a larger battery before the study started and included one task measuring brain responses, two measures of executive function in the lab, and a parent questionnaire. Changes in social functioning and repetitive behaviors were also explored. All children assigned to training completed the program and families generally reported the experience was positive. Brain responses of the training group changed following training, but not within the waiting group during a similar time period. Children who received training did not exhibit behavioral changes during the two the lab-based tasks. Parent report on questionnaires indicated that neither group showed a significant change in their broad use of executive function in other settings. Yet, children who received training were reported to have fewer restricted and repetitive behaviors following training. These initial findings suggest that short executive function training activities are feasible and may improve some functioning of school-aged children on the autism spectrum.

Modulating fluid intelligence performance through combined cognitive training and brain stimulation

Executive functions (EF) are impaired in children with attention-deficit/hyperactivity disorder (ADHD). It may be especially critical for interventions to target EF in early childhood given the developmental progression of EF deficits that may contribute to later functional impairments. This proof-of-concept study examined the initial efficacy of an intervention program on EF and ADHD. We also examined child performance on three neurocognitive tasks assessing cognitive flexibility, auditory/visual attention, and sustained/selective attention. Children with ADHD (ages 3-7) and their parents were randomized to receive an intervention targeting metacognitive EF deficits (n=13) or to a waitlist control condition (n=12). Linear model analysis of covariance compared groups on parent EF ratings, blinded clinician ratings of ADHD symptoms and improvement, and child performance on neurocognitive measures. Children who received the intervention significantly improved on parent ratings of attention shifting and emotion regulation in addition to clinician ratings of inattention. Moderate effect sizes showed additional intervention effects on parent ratings of inhibition, memory, and planning, and clinician ratings of hyperactivity/impulsivity and overall improvement. Small effect sizes were observed for improvement on child neurocognitive measures. Although replication with a larger sample and an active control group is needed, EF training with a metacognitive focus is a potentially promising intervention for young children with ADHD.

As mnemonic utilization deficit in older adults associates with age-related decline in executive function, we hypothesized that memory strategy training combined with executive function training might induce larger training effect in memory and broader training effects in non-memory outcomes than pure memory training. The present study compared the effects of combined cognitive training (executive function training plus memory strategy training) to pure memory strategy training. Forty healthy older adults were randomly assigned to a combined cognitive training group or a memory strategy training group. A control group receiving no training was also included. Combined cognitive training group received 16 sessions of training (eight sessions of executive function training followed by eight sessions of memory strategy training). Memory training group received 16 sessions of memory strategy training. The results partly supported our hypothesis in that indeed improved performance on executive function was only found in combined training group, whereas memory performance increased less in combined training compared to memory strategy group. Results suggest that combined cognitive training may be less efficient than pure memory training in memory outcomes, though the influences from insufficient training time and less closeness between trained executive function and working memory could not be excluded; however it has broader training effects in non-memory outcomes. Clinical Trial Registration: www.chictr.org.cn, identifier ChiCTR-OON-16007793.

With increased population aging, cognitive training has emerged as a popular intervention for combating age-related cognitive decline. Considering the purpose of cognitive interventions, the development of cognitive training programs typically focuses on properties that may enhance cognition, often neglecting the key element of user engagement. Consequently, many cognitive training studies have reported poor adherence and high participant attrition. To increase the likelihood of long-term cognitive benefits, there must be sustained use of the intervention (i.e., good training program adherence). Utilizing a research-through-design approach, this paper presents the design and development of a cognitive training program for older adults. Specifically, the primary focus was on outlining a conceptual framework for developing this program, which draws from gamification principles to foster motivation and enjoyment, as well as cognitive plasticity and transfer principles to foster cognitive engagement. Overall, the program encompasses gamified, adaptive, multidomain training of core executive functions (working memory, inhibitory control, and cognitive flexibility). This program will be the basis for future works exploring older adults’ experiences and preferences of cognitive training, and evaluating the efficacy of multidomain executive functions training in enhancing cognition and well-being in older age.

Nursing Studies and concluded: 'we are unclear if the authors have reported a single trial of the same intervention that is reported across multiple papers.If this is the case the authors need to explain why the interventions are apparently different.Alternatively, the authors may have reported two separate trials and inadvertently used the same registration number.If this is the case, the authors need to explain why the demographic characteristics of control participants are identical in both studies'.

There is controversy regarding the clinical efficacy of neurofeedback (NF) and computerized cognitive training (CogT) as treatments for ADHD. Meta-analyses claim that probably blinded teachers observe smaller effects than parents, because they are less biased. We investigated informant-specific effects by manipulating the involvement of informants, by controlling for waiting time effects, and by adding a blinded outcome measure. Seventy-seven children with ADHD were randomly allocated to slow cortical potential NF or to individualized CogT (of attention, working memory or inhibition). The training was conducted in schools (NF: n=19, CogT: n=19) or in outpatient clinics (NF: n=19, CogT: n=20). Three assessments were scheduled: baseline, followed by a waiting period, pre-training, and post-training. Multivariate Analyses of Variance were conducted to assess parent- and teacher-rated changes in ADHD symptoms and executive functions (EF), and changes according to standardized classroom observations. Both treatments resulted in significant improvements according to informants, with larger effects for parents (ADHD symptoms: parent η p2 =.32; teacher η p2 =.10), and according to observations (η p2 =.19). The setting had no effect on outcome. Considerable waiting time effects were revealed for ADHD symptom ratings by both informants, for EF ratings only by teachers. Changed classroom behavior was uncorrelated with teacher-rated changes. Overall, the results do not support the notion that teachers are more objective while being as sensitive to change as parents. The three sources seem to contribute differential and mostly unrelated pieces of information to the evaluation of treatments.

Cognitive training programs have been attempted to improve cognition in cognitively vulnerable people living with HIV (PLWH). Some have attempted to improve episodic memory or speed of processing, while others have used an individualized cognitive domain approach targeting each person's cognitive deficits. Although effective, none of these approaches considered the influence of cognitive intra-individual variability (IIV). Cognitive IIV refers to the fluctuations in one's individual cognitive ability across cognitive domains (dispersion) or within the same test (inconsistency). Greater cognitive IIV predicts cognitive decline as well as decreased cognitive integrity and increased neuropathology. Some neuroscientists posited that poor executive functioning, known as the Executive Dyscontrol Hypothesis, increases cognitive IIV. Thus, if we can improve executive functioning, we may be able to decrease cognitive IIV and improve overall cognitive functioning. This article provides the rationale and protocol for a feasibility clinical trial examining an executive functioning training intervention in middle-aged and older PLWH. This study utilizes a two-arm baseline/posttest experimental design to examine the primary aim 1 (feasibility and acceptability) and the exploratory aim 1 (cognition) in 120 community-dwelling PLWH aged 40 and older. Participants will be randomized into one of the two arms: 1) 20 hours of computerized executive functioning training group, or 2) a no-contact control group. The proposed training time is 10 to 12 weeks (1 to 2 one-hour training sessions/week, while working around participants' schedules). At baseline and posttest, participants will receive a 1.5 to 2-hour assessment that includes many measures including the Connor's Continuous Performance Test (Version 3), and a 50-minute self-administered computerized cognitive performance battery (BRACE+ = BrainBaseline Assessment of Cognition and Everyday Functioning). This study tests an innovative intervention designed to reduce cognitive IIV; to our knowledge, no other study has targeted cognitive IIV as an intervention outcome.

Recent psycholinguistics research suggests that the executive function (EF) skill known as conflict resolution – the ability to adjust behavior in the service of resolving among incompatible representations – is important for several language processing tasks such as lexical and syntactic ambiguity resolution, verbal fluency, and common-ground assessment. Here, we discuss work showing that various EF skills can be enhanced through consistent practice with working-memory tasks that tap these EFs, and, moreover, that improvements on the training tasks transfer across domains to novel tasks that may rely on shared underlying EFs. These findings have implications for language processing and could launch new research exploring if EF training, within a “process-specific” framework, could be used as a remediation tool for improving general language use. Indeed, work in our lab demonstrates that EF training that increases conflict-resolution processes has selective benefits on an untrained sentence-processing task requiring syntactic ambiguity resolution, which relies on shared conflict-resolution functions. Given claims that conflict-resolution abilities contribute to a range of linguistic skills, EF training targeting this process could theoretically yield wider performance gains beyond garden-path recovery. We offer some hypotheses on the potential benefits of EF training as a component of interventions to mitigate general difficulties in language processing. However, there are caveats to consider as well, which we also address.

Executive function deficits are well-established in ADHD. Unfortunately, replicated evidence indicates that executive function training for ADHD has been largely unsuccessful. We hypothesized that this may reflect insufficient targeting, such that extant protocols do not sufficiently and specifically target the neurocognitive systems associated with phenotypic ADHD behaviors/impairments. Children with ADHD ages 8-12 (M = 10.41, SD = 1.46; 12 girls; 74% Caucasian/Non-Hispanic) were randomized with allocation concealment to either central executive training (CET; n = 25) or newly developed inhibitory control training (ICT; n = 29). Detailed data analytic plans were preregistered. Both treatments were feasible/acceptable based on training duration, child-reported ease of use, and parent-reported high satisfaction. CET was superior to ICT for improving its primary intervention targets: phonological and visuospatial working memory (d = 0.70-0.84). CET was also superior to ICT for improving go/no-go (d = 0.84) but not stop-signal inhibition. Mechanisms of change analyses indicated that CET-related working memory improvements produced significant reductions in the primary clinical endpoints (objectively assessed hyperactivity) during working memory and inhibition testing (indirect effects: β ≥ -.11; 95% CIs exclude 0.0). CET was also superior to ICT on 3 of 4 secondary clinical endpoints (blinded teacher-rated ADHD symptoms; d = 0.46-0.70 vs. 0.16-0.42) and 2 of 4 feasibility/acceptability clinical endpoints (parent-reported ADHD symptoms; d = 0.96-1.42 vs. 0.45-0.65). CET-related gains were maintained at 2-4 month follow-up; ICT-related gains were maintained for attention problems but not hyperactivity/impulsivity per parent report. Results support the use of CET for treating executive function deficits and targeting ADHD behavioral symptoms in children with ADHD. Findings for ICT were mixed at best and indicate the need for continued development/study. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The study examined how executive function (EF) training could improve children’s emotional competence (EC). Children (N = 55; Mage = 50.64 months) were assigned into two groups, namely the EF training group and the no-training group. The present study attempted to use a 2 (group: EF training VS no-training) × 2 (test time: pretest VS post-test) between-and- within-subjects experimental design to investigate the effect of EF training on the improvement of EC for 4-year-old children. Results showed that, (1) children in EF training group had significantly higher scores on EC than that of no-training group; (2) The change of inhibition control and working memory could significantly predict their variation of EC. These results suggested that the improvement of EC caused by EF training could be linked to the ability of inhibition control and working memory.

Background/Objectives: The evolution of digital technology enhances the broadening of a person's intellectual growth. Research points out that implementing innovative applications of the digital world improves human social, cognitive, and metacognitive behavior. Artificial intelligence chatbots are yet another innovative human-made construct. These are forms of software that simulate human conversation, understand and process user input, and provide personalized responses. Executive function includes a set of higher mental processes necessary for formulating, planning, and achieving a goal. The present study aims to investigate executive function reinforcement through artificial intelligence chatbots, outlining potentials, limitations, and future research suggestions. Specifically, the study examined three research questions: the use of conversational chatbots in executive functioning training, their impact on executive-cognitive skills, and the duration of any improvements. Methods: The assessment of the existing literature was implemented using the systematic review method, according to the PRISMA 2020 Principles. The avalanche search method was employed to conduct a source search in the following databases: Scopus, Web of Science, PubMed, and complementary Google Scholar. This systematic review included studies from 2021 to the present using experimental, observational, or mixed methods. It included studies using AI-based chatbots or conversationalists to support executive functions, such as anxiety, stress, depression, memory, attention, cognitive load, and behavioral changes. In addition, this study included general populations with specific neurological conditions, all peer-reviewed, written in English, and with full-text access. However, the study excluded studies before 2021, the literature reviews, systematic reviews, non-AI-based chatbots or conversationalists, studies not targeting the range of executive skills and abilities, studies not written in English, and studies without open access. The criteria aligned with the study objectives, ensuring a focus on AI chatbots and the impact of conversational agents on executive function. The initial collection totaled n = 115 articles; however, the eligibility requirements led to the final selection of n = 10 studies. Results: The findings of the studies suggested positive effects of using AI chatbots to enhance and improve executive skills. Although, several limitations were identified, making it still difficult to generalize and reproduce their effects. Conclusions: AI chatbots are an innovative artificial intelligence tool that can function as a digital assistant for learning and expanding executive skills, contributing to the cognitive, metacognitive, and social development of the individual. However, its use in executive skills training is at a primary stage. The findings highlighted the need for a unified framework for reference and future studies, better study designs, diverse populations, larger sample sizes of participants, and longitudinal studies that observe the long-term effects of their use.

Difficulties with emotion regulation affect the majority of youth with attention-deficit/hyperactivity disorder (ADHD) and predict greater functional impairment than ADHD symptoms alone. Deficits in executive functioning are also present for most children with ADHD, and have been linked with emotion regulation difficulties in both clinical and neurotypical populations throughout development. The current study was the first to assess all three core executive functions (working memory, inhibitory control, set shifting) simultaneously in a clinically-diverse sample of children with and without ADHD and common comorbidities and investigate the extent to which they uniquely predict emotion dysregulation. A sample of 151 children ages 8-13years (M = 10.36, SD = 1.52; 52 girls; 70.2% White/Non-Hispanic) were assessed using a criterion battery of executive functioning tasks, teacher-reported ADHD symptoms, and parent-reported emotion regulation. Results of the bias-corrected, bootstrapped conditional effects path model revealed that better-developed working memory predicted better emotion regulation (β = 0.23) and fewer ADHD symptoms (β = -0.21 to -0.37), that ADHD symptoms (β = -0.18 to -0.20) independently predicted emotion dysregulation, and that working memory exerted indirect effects on emotion regulation through both inattention and hyperactivity/impulsivity (β = 0.04-0.07). Sensitivity analyses indicated that these effects were generally robust to control for age, sex, executive function interrelations, and inclusion/exclusion of children with co-occurring ASD. These findings underscore the importance of working memory (relative to inhibitory control and set shifting) and its relations with ADHD symptoms for understanding children's emotion regulation skills, and may help explain the limited efficacy of first-line ADHD treatments, which do not target working memory, for improving emotion regulation skills.

Deficits in executive function (EF), impaired school functioning and altered white matter integrity in frontostriatal networks have been associated with attention-deficit/hyperactivity disorder (ADHD). However, relationships between impairments in these areas are unclear. Using a sample of youths with and without ADHD, this study examined the association between microstructural integrity of frontostriatal tracts and school dysfunction and the mediating roles of EF and ADHD symptoms in this association. The sample included 32 Taiwanese youths with ADHD and 32 age-, sex-, handedness- and IQ-matched typically-developing (TD) youths. Participants were assessed using psychiatric interviews, parent reports on ADHD symptoms and school functioning, and EF measures from the Cambridge Neuropsychological Test Automated Battery (CANTAB). The frontostriatal tracts were reconstructed by diffusion spectrum imaging (DSI) tractography and were subdivided into four functionally distinct segments: caudate-dorsolateral, caudate-medial prefrontal, caudate-orbitofrontal and caudate-ventrolateral tracts. Youths with ADHD, relative to TD youths, showed altered white matter integrity in all four bilateral pairs of frontostriatal tracts (decreased general fractional anisotropy, GFA), had poor attention, vigilance and response inhibition, and showed impaired school functioning. Altered microstructural integrity in frontostriatal tracts was significantly associated with school dysfunction, which was mediated by EF measures of attention/vigilance and response inhibition in addition to inattention and hyperactivity symptoms. Our findings demonstrate an association between white matter integrity in the frontostriatal networks and school functioning and suggest that EF deficits and ADHD symptoms may be the mediating mechanisms for this association. Future research is needed to test the directionality and specificity of this finding.