Computerized cognitive training in attention-deficit/hyperactivity disorder (ADHD): A meta-analysis of randomized controlled trials with blinded and objective outcomes

Samuel Westwood; Valeria Parlatini; Katya Rubia; Samuele Cortese; Edmund Sonuga-Barke; European ADHD Guidelines Group (EAGG)

doi:10.1038/s41380-023-02000-7

Computerized cognitive training in attention-deficit/hyperactivity disorder (ADHD): A meta-analysis of randomized controlled trials with blinded and objective outcomes

Samuel Westwood, Valeria Parlatini, Katya Rubia, Samuele Cortese, Edmund Sonuga-Barke, European ADHD Guidelines Group (EAGG)

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Abstract

This meta-analysis investigated the effects of computerized cognitive training (CCT) on clinical, neuropsychological and academic outcomes in individuals with attention-deficit/hyperactivity disorder (ADHD). The authors searched PubMed, Ovid, and Web of Science until 19th January 2022 for parallel-arm randomized controlled trials (RCTs) using CCT in individuals with ADHD. Random-effects meta-analyses pooled standardized mean differences (SMD) between CCT and comparator arms. RCT quality was assessed with the Cochrane Risk of Bias 2.0 tool (PROSPERO: CRD42021229279). Thirty-six RCTs were meta-analysed, 17 of which evaluated working memory training (WMT). Analysis of outcomes measured immediately post-treatment and judged to be “probably blinded” (PBLIND; trial n = 14) showed no effect on ADHD total (SMD = 0.12, 95%CI[−0.01 to −0.25]) or hyperactivity/impulsivity symptoms (SMD = 0.12, 95%[−0.03 to−0.28]). These findings remained when analyses were restricted to trials (n: 5–13) with children/adolescents, low medication exposure, semi-active controls, or WMT or multiple process training. There was a small improvement in inattention symptoms (SMD = 0.17, 95%CI[0.02–0.31]), which remained when trials were restricted to semi-active controls (SMD = 0.20, 95%CI[0.04–0.37]), and doubled in size when assessed in the intervention delivery setting (n = 5, SMD = 0.40, 95%CI[0.09–0.71]), suggesting a setting-specific effect. CCT improved WM (verbal: n = 15, SMD = 0.38, 95%CI[0.24–0.53]; visual-spatial: n = 9, SMD = 0.49, 95%CI[0.31–0.67]), but not other neuropsychological (e.g., attention, inhibition) or academic outcomes (e.g., reading, arithmetic; analysed n: 5–15). Longer-term improvement (at ~6-months) in verbal WM, reading comprehension, and ratings of executive functions were observed but relevant trials were limited in number (n: 5–7). There was no evidence that multi-process training was superior to working memory training. In sum, CCT led to shorter-term improvements in WM, with some evidence that verbal WM effects persisted in the longer-term. Clinical effects were limited to small, setting specific, short-term effects on inattention symptoms.

Original language	English
Pages (from-to)	1402-1414
Number of pages	13
Journal	Molecular Psychiatry
Volume	28
Issue number	4
Early online date	29 Mar 2023
DOIs	https://doi.org/10.1038/s41380-023-02000-7
Publication status	Published - Apr 2023

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Westwood, S., Parlatini, V., Rubia, K., Cortese, S., Sonuga-Barke, E., & European ADHD Guidelines Group (EAGG) (2023). Computerized cognitive training in attention-deficit/hyperactivity disorder (ADHD): A meta-analysis of randomized controlled trials with blinded and objective outcomes. Molecular Psychiatry, 28(4), 1402-1414. https://doi.org/10.1038/s41380-023-02000-7

@article{c6e170785e0642b5afb8f8ea1e6e31d9,

title = "Computerized cognitive training in attention-deficit/hyperactivity disorder (ADHD): A meta-analysis of randomized controlled trials with blinded and objective outcomes",

abstract = "This meta-analysis investigated the effects of computerized cognitive training (CCT) on clinical, neuropsychological and academic outcomes in individuals with attention-deficit/hyperactivity disorder (ADHD). The authors searched PubMed, Ovid, and Web of Science until 19th January 2022 for parallel-arm randomized controlled trials (RCTs) using CCT in individuals with ADHD. Random-effects meta-analyses pooled standardized mean differences (SMD) between CCT and comparator arms. RCT quality was assessed with the Cochrane Risk of Bias 2.0 tool (PROSPERO: CRD42021229279). Thirty-six RCTs were meta-analysed, 17 of which evaluated working memory training (WMT). Analysis of outcomes measured immediately post-treatment and judged to be “probably blinded” (PBLIND; trial n = 14) showed no effect on ADHD total (SMD = 0.12, 95%CI[−0.01 to −0.25]) or hyperactivity/impulsivity symptoms (SMD = 0.12, 95%[−0.03 to−0.28]). These findings remained when analyses were restricted to trials (n: 5–13) with children/adolescents, low medication exposure, semi-active controls, or WMT or multiple process training. There was a small improvement in inattention symptoms (SMD = 0.17, 95%CI[0.02–0.31]), which remained when trials were restricted to semi-active controls (SMD = 0.20, 95%CI[0.04–0.37]), and doubled in size when assessed in the intervention delivery setting (n = 5, SMD = 0.40, 95%CI[0.09–0.71]), suggesting a setting-specific effect. CCT improved WM (verbal: n = 15, SMD = 0.38, 95%CI[0.24–0.53]; visual-spatial: n = 9, SMD = 0.49, 95%CI[0.31–0.67]), but not other neuropsychological (e.g., attention, inhibition) or academic outcomes (e.g., reading, arithmetic; analysed n: 5–15). Longer-term improvement (at ~6-months) in verbal WM, reading comprehension, and ratings of executive functions were observed but relevant trials were limited in number (n: 5–7). There was no evidence that multi-process training was superior to working memory training. In sum, CCT led to shorter-term improvements in WM, with some evidence that verbal WM effects persisted in the longer-term. Clinical effects were limited to small, setting specific, short-term effects on inattention symptoms.",

author = "Samuel Westwood and Valeria Parlatini and Katya Rubia and Samuele Cortese and Edmund Sonuga-Barke and {European ADHD Guidelines Group (EAGG)}",

note = "Funding Information: We would like to thank the following authors for providing methodological details and/or data Aitana Bigorra, Aida Bikic, Amelie Dentz, Sebastian Dovis, Virginia de Oliveira Rosa, Jans Egeland, Sarah Gray, John Hasslinger, Pietro Iaffaldano, Ana-Maria Iosif, Susanne Jaeggi, Masha Jones, Tara McAuley Torkel Klingberg, Scott Kollins, Ramon Medina, Kristin Meyer David Rabiner, Juha Salmi, Lilach Shalev, Adi Stern, Julie Schweitzer, Margret Sheridan, Oliver Tucha, Saskia van der Oord, Alessandro Villa, and Maarit Virta Funding Information: SJW and VP declare not conflicts of interest. KR has received a grant from Takeda pharmaceuticals and consulting fees from Supernus and Lundbeck. She is supported by the UK Department of Health via the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) for Mental Health at South London and the Maudsley National Health Service (NHS) Foundation Trust and the IoPPN, King{\textquoteright}s College London. SCo declares honoraria and reimbursement for travel and accommodation expenses for lectures from the following non-profit associations: Association for Child and Adolescent Central Health (ACAMH), Canadian ADHD Alliance Resource (CADDRA), British Association of Pharmacology (BAP), and from Healthcare Convention for educational activity on ADHD. ESB reports being an speaker for Medice and Shire (Takeda) in the last three years; being a consultant for Neurotech Solutions International; holding grant funding from QBTech; receiving an annual honorarium from the JCPP.CH declares funding from the National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre and MindTech Medtech Co-operative. PS is the CEO and shareholder of HealthTracker Ltd and has received research funds from Newron Pharmaceuticals SpA, GWPharma, and Anavex Life Sciences Corp. Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = apr,

doi = "10.1038/s41380-023-02000-7",

language = "English",

volume = "28",

pages = "1402--1414",

journal = "Molecular Psychiatry",

issn = "1476-5578",

publisher = "Springer Nature [academic journals on nature.com]",

number = "4",

}

Westwood, S , Parlatini, V , Rubia, K, Cortese, S, Sonuga-Barke, E & European ADHD Guidelines Group (EAGG) 2023, 'Computerized cognitive training in attention-deficit/hyperactivity disorder (ADHD): A meta-analysis of randomized controlled trials with blinded and objective outcomes', Molecular Psychiatry, vol. 28, no. 4, pp. 1402-1414. https://doi.org/10.1038/s41380-023-02000-7

TY - JOUR

T1 - Computerized cognitive training in attention-deficit/hyperactivity disorder (ADHD): A meta-analysis of randomized controlled trials with blinded and objective outcomes

AU - Westwood, Samuel

AU - Parlatini, Valeria

AU - Rubia, Katya

AU - Cortese, Samuele

AU - Sonuga-Barke, Edmund

AU - European ADHD Guidelines Group (EAGG)

N1 - Funding Information: We would like to thank the following authors for providing methodological details and/or data Aitana Bigorra, Aida Bikic, Amelie Dentz, Sebastian Dovis, Virginia de Oliveira Rosa, Jans Egeland, Sarah Gray, John Hasslinger, Pietro Iaffaldano, Ana-Maria Iosif, Susanne Jaeggi, Masha Jones, Tara McAuley Torkel Klingberg, Scott Kollins, Ramon Medina, Kristin Meyer David Rabiner, Juha Salmi, Lilach Shalev, Adi Stern, Julie Schweitzer, Margret Sheridan, Oliver Tucha, Saskia van der Oord, Alessandro Villa, and Maarit Virta Funding Information: SJW and VP declare not conflicts of interest. KR has received a grant from Takeda pharmaceuticals and consulting fees from Supernus and Lundbeck. She is supported by the UK Department of Health via the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) for Mental Health at South London and the Maudsley National Health Service (NHS) Foundation Trust and the IoPPN, King’s College London. SCo declares honoraria and reimbursement for travel and accommodation expenses for lectures from the following non-profit associations: Association for Child and Adolescent Central Health (ACAMH), Canadian ADHD Alliance Resource (CADDRA), British Association of Pharmacology (BAP), and from Healthcare Convention for educational activity on ADHD. ESB reports being an speaker for Medice and Shire (Takeda) in the last three years; being a consultant for Neurotech Solutions International; holding grant funding from QBTech; receiving an annual honorarium from the JCPP.CH declares funding from the National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre and MindTech Medtech Co-operative. PS is the CEO and shareholder of HealthTracker Ltd and has received research funds from Newron Pharmaceuticals SpA, GWPharma, and Anavex Life Sciences Corp. Publisher Copyright: © 2023, The Author(s).

PY - 2023/4

Y1 - 2023/4

N2 - This meta-analysis investigated the effects of computerized cognitive training (CCT) on clinical, neuropsychological and academic outcomes in individuals with attention-deficit/hyperactivity disorder (ADHD). The authors searched PubMed, Ovid, and Web of Science until 19th January 2022 for parallel-arm randomized controlled trials (RCTs) using CCT in individuals with ADHD. Random-effects meta-analyses pooled standardized mean differences (SMD) between CCT and comparator arms. RCT quality was assessed with the Cochrane Risk of Bias 2.0 tool (PROSPERO: CRD42021229279). Thirty-six RCTs were meta-analysed, 17 of which evaluated working memory training (WMT). Analysis of outcomes measured immediately post-treatment and judged to be “probably blinded” (PBLIND; trial n = 14) showed no effect on ADHD total (SMD = 0.12, 95%CI[−0.01 to −0.25]) or hyperactivity/impulsivity symptoms (SMD = 0.12, 95%[−0.03 to−0.28]). These findings remained when analyses were restricted to trials (n: 5–13) with children/adolescents, low medication exposure, semi-active controls, or WMT or multiple process training. There was a small improvement in inattention symptoms (SMD = 0.17, 95%CI[0.02–0.31]), which remained when trials were restricted to semi-active controls (SMD = 0.20, 95%CI[0.04–0.37]), and doubled in size when assessed in the intervention delivery setting (n = 5, SMD = 0.40, 95%CI[0.09–0.71]), suggesting a setting-specific effect. CCT improved WM (verbal: n = 15, SMD = 0.38, 95%CI[0.24–0.53]; visual-spatial: n = 9, SMD = 0.49, 95%CI[0.31–0.67]), but not other neuropsychological (e.g., attention, inhibition) or academic outcomes (e.g., reading, arithmetic; analysed n: 5–15). Longer-term improvement (at ~6-months) in verbal WM, reading comprehension, and ratings of executive functions were observed but relevant trials were limited in number (n: 5–7). There was no evidence that multi-process training was superior to working memory training. In sum, CCT led to shorter-term improvements in WM, with some evidence that verbal WM effects persisted in the longer-term. Clinical effects were limited to small, setting specific, short-term effects on inattention symptoms.

AB - This meta-analysis investigated the effects of computerized cognitive training (CCT) on clinical, neuropsychological and academic outcomes in individuals with attention-deficit/hyperactivity disorder (ADHD). The authors searched PubMed, Ovid, and Web of Science until 19th January 2022 for parallel-arm randomized controlled trials (RCTs) using CCT in individuals with ADHD. Random-effects meta-analyses pooled standardized mean differences (SMD) between CCT and comparator arms. RCT quality was assessed with the Cochrane Risk of Bias 2.0 tool (PROSPERO: CRD42021229279). Thirty-six RCTs were meta-analysed, 17 of which evaluated working memory training (WMT). Analysis of outcomes measured immediately post-treatment and judged to be “probably blinded” (PBLIND; trial n = 14) showed no effect on ADHD total (SMD = 0.12, 95%CI[−0.01 to −0.25]) or hyperactivity/impulsivity symptoms (SMD = 0.12, 95%[−0.03 to−0.28]). These findings remained when analyses were restricted to trials (n: 5–13) with children/adolescents, low medication exposure, semi-active controls, or WMT or multiple process training. There was a small improvement in inattention symptoms (SMD = 0.17, 95%CI[0.02–0.31]), which remained when trials were restricted to semi-active controls (SMD = 0.20, 95%CI[0.04–0.37]), and doubled in size when assessed in the intervention delivery setting (n = 5, SMD = 0.40, 95%CI[0.09–0.71]), suggesting a setting-specific effect. CCT improved WM (verbal: n = 15, SMD = 0.38, 95%CI[0.24–0.53]; visual-spatial: n = 9, SMD = 0.49, 95%CI[0.31–0.67]), but not other neuropsychological (e.g., attention, inhibition) or academic outcomes (e.g., reading, arithmetic; analysed n: 5–15). Longer-term improvement (at ~6-months) in verbal WM, reading comprehension, and ratings of executive functions were observed but relevant trials were limited in number (n: 5–7). There was no evidence that multi-process training was superior to working memory training. In sum, CCT led to shorter-term improvements in WM, with some evidence that verbal WM effects persisted in the longer-term. Clinical effects were limited to small, setting specific, short-term effects on inattention symptoms.

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U2 - 10.1038/s41380-023-02000-7

DO - 10.1038/s41380-023-02000-7

M3 - Review article

SN - 1476-5578

VL - 28

SP - 1402

EP - 1414

JO - Molecular Psychiatry

JF - Molecular Psychiatry

IS - 4

ER -

Computerized cognitive training in attention-deficit/hyperactivity disorder (ADHD): A meta-analysis of randomized controlled trials with blinded and objective outcomes

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