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Review
. 2023 Apr;28(4):1402-1414.
doi: 10.1038/s41380-023-02000-7. Epub 2023 Mar 29.

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

Samuel J Westwood  1   2 , Valeria Parlatini  3 , Katya Rubia  3 , Samuele Cortese  4   5   6   7   8 , Edmund J S Sonuga-Barke  9 ; European ADHD Guidelines Group (EAGG)
Collaborators, Affiliations
Review

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

Samuel J Westwood et al. Mol Psychiatry. 2023 Apr.

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.

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Conflict of interest statement

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.

Figures

Fig. 1
Fig. 1. Forest plots for meta-analysis of effects of PBLIND outcome measures of ADHD total symptoms.
Note. CCT Computerized Cognitive Training, SE Standard Error, Std. Standardised.
Fig. 2
Fig. 2. Forest plots for meta-analysis of effects PBLIND outcome measures of Inattention or Hyperactivity/Impulsivity symptoms.
Note. CCT Computerized Cognitive Training, SE Standard Error, Std. Standardized.
Fig. 3
Fig. 3. Forest plots for meta-analysis of effects on verbal and visual-spatial short-term and working memory tasks.
CCT Computerized Cognitive Training, SE Standard Error, Std. Standardized.
See this image and copyright information in PMC

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