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Randomized Controlled Trial
. 2024 Oct:181:104615.
doi: 10.1016/j.brat.2024.104615. Epub 2024 Aug 19.

A randomized clinical trial to evaluate feasibility, tolerability, and preliminary target engagement for a novel executive working memory training in adolescents with ADHD

Abigail J Sullivan  1 , Jacey Anderson  2 , Morgan Beatty  2 , Jimmy Choi  2 , James Jaccard  3 , Keith Hawkins  4 , Godfrey Pearlson  5 , Michael C Stevens  5
Affiliations
Randomized Controlled Trial

A randomized clinical trial to evaluate feasibility, tolerability, and preliminary target engagement for a novel executive working memory training in adolescents with ADHD

Abigail J Sullivan et al. Behav Res Ther. 2024 Oct.

Abstract

Objective: Working memory training for Attention-Deficit/Hyperactivity Disorder (ADHD) has focused on increasing working memory capacity, with inconclusive evidence for its effectiveness. Alternative training targets are executive working memory (EWM) processes that promote flexibility or bolster stability of working memory contents to guide behavior via selective attention. This randomized, placebo-controlled study was designed to assess feasibility, tolerability, and behavioral target engagement of a novel EWM training for ADHD.

Method: 62 ADHD-diagnosed adolescents (12-18 years) were randomized to EWM training or placebo arms for 20 remotely coached sessions conducted over 4-5 weeks. Primary outcome measures were behavioral changes on EWM tasks. Secondary outcomes were intervention tolerability, trial retention, and responsiveness to adaptive training difficulty manipulations.

Results: Linear regression analyses found intervention participants showed medium effect size improvements, many of which were statistically significant, on Shifting and Filtering EWM task accuracy and Shifting and Updating reaction time measures. Intervention participants maintained strong self-rated motivation, mood, and engagement and progressed through the adaptive difficulty measures, which was further reflected in high trial retention.

Conclusions: The results suggest that these EWM processes show promise as training targets for ADHD. The subsequent NIMH R33-funded extension clinical trial will seek to replicate and extend these findings.

Keywords: Attention-deficit/hyperactivity disorder (ADHD); Clinical trial; Executive working memory; Randomized controlled trial; Training.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Michael C. Stevens reports financial support was provided by National Institute of Mental Health. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1.
Figure 1.
Flow of Study Procedures
Figure 2.
Figure 2.
Exemplary Sequences of EWM training exercises.
Figure 3.
Figure 3.
CONSORT diagram
Figure 4.
Figure 4.
Tier Performance by Session for Each Group
See this image and copyright information in PMC

References

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