Training cognition in ADHD: current findings, borrowed concepts, and future directions

Abstract

With both its high prevalence and myriad of negative outcomes, Attention-Deficit/Hyperactivity Disorder (ADHD) demands a careful consideration of the efficacy of its treatment options. Although the benefits of medication have a robust empirical background, nonpharmaceutical interventions evoke particular interest, as they are often viewed more favorably by parents. This review pays special attention to the use of working memory and recent cognitive training attempts in ADHD, describing its cognitive, behavioral, and biological effects in relation to current neurological theory of the disorder. While these treatments have demonstrated positive effects on some measures, there are limitations, as studies have failed to demonstrate generalization to critical measures, such as teacher-rated classroom behaviors, and have provided limited but growing evidence of functionally significant improvements in behavior. There is also a clear lack of research on the effects of training on reward systems and self-control. These limitations may be addressed by broadening the scope and procedures of the training and incorporating research concepts from other fields of study. First, it is important to consider the developmental trajectories of brain regions in individuals with the disorder, as they may relate to the effectiveness of cognitive training. Notions from behavioral economics, including delay discounting and framing (i.e., context) manipulations that influence present orientation, also have applications in the study of cognitive training in ADHD. In considering these other domains, we may find new ways to conceptualize and enhance cognitive training in ADHD and, in turn, address current limitations of interventions that fall in this category.

Fig. 1

(A) Visualization of the valuation network (red) and the control network (blue). (B) Results from McClure et al. [42] show that impulsive choices were associated with relatively more activity in the valuation network, whereas future oriented choices were associated with more activity in the control network. (C) Neurobiological model of cognitive and motivational processes showing linear development of top down prefrontal control network relative to a ∩-shaped function for the development of valuation network (based on Somerville and Casey [84]). (D) Plot showing two discount curves based on four indifference points of a relatively impulsive person with ADHD and a more patient control participant; the arrow indicates the proposed effect of training on the discount curve