Journal of the Korean Academy of Child and Adolescent Psychiatry

Korean Academy of Child and Adolescent Psychiatry (대한소아청소년정신의학회)
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Augmentative Effects of Working Memory Training on Clinical Symptoms and Neuropsychology in Medicated Children and Adolescents with Attention-Deficit Hyperactivity Disorder

약물치료 중인 주의력결핍 과잉행동장애 아동 청소년에서 작업기억력 훈련이 임상증상과 신경심리소견에 미치는 부가적 효과

  • Received : 2016.10.20
  • Accepted : 2017.02.18
  • Published : 2017.04.01
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Abstract

Objectives: Executive dysfunction including working memory deficit has been suggested to be one of the major neuropsychological etiologies of attention-deficit hyperactivity disorder (ADHD). The purpose of this study was to investigate the augmentative effects of Cogmed working memory training on the symptoms and neurocognitive functions in medicated children and adolescents with ADHD. Methods: Twenty-five children with ADHD, aged 7 to 19 years, taking ADHD medication participated in this study. The participants were trained for 5 weeks with a commercially available and computerized working memory program ($Cogmed^{(R)}$) without any changes to their medication. The Korean version of the ADHD Rating Scale, Clinical Global Impression Scale, and Comprehensive Attention Test were administered before training and 4 weeks and 7 months after training, respectively. Results: After completing the training, the clinical symptoms and function, rated by the parents and clinician, were improved. In addition, the level of commission errors was significantly reduced in the selective attention (visual/auditory) task, sustained attention to response task, and flanker task. The untrained visuospatial short-term memory and working memory were also improved. These effects were still observed 7 months after the training. Conclusion: Cogmed working memory training can be a promising training option for the additional improvement of the symptoms and deficits in working memory and response inhibition in medicated children with ADHD.

Keywords

References

  1. Dulcan M. Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder. American Academy of Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry 1997;36(10 Suppl):85S-121S. https://doi.org/10.1097/00004583-199710001-00007
  2. Barkley RA. ADHD in adults: developmental course and outcome of children with ADHD, and ADHD in clinic-referred adults. In: Barkley RA, editor. Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment. 3rd ed. New York: Guilford Press; 2006. p.248-296.
  3. Nigg JT. Neuropsychologic theory and findings in attention-deficit/hyperactivity disorder: the state of the field and salient challenges for the coming decade. Biol Psychiatry 2005;57:1424-1435. https://doi.org/10.1016/j.biopsych.2004.11.011
  4. Seidman LJ. Neuropsychological functioning in people with ADHD across the lifespan. Clin Psychol Rev 2006;26:466-485. https://doi.org/10.1016/j.cpr.2006.01.004
  5. Nigg JT, Stavro G, Ettenhofer M, Hambrick DZ, Miller T, Henderson JM. Executive functions and ADHD in adults: evidence for selective effects on ADHD symptom domains. J Abnorm Psychol 2005;114:706-717. https://doi.org/10.1037/0021-843X.114.3.706
  6. Barkley RA. Major life activity and health outcomes associated with attention-deficit/hyperactivity disorder. J Clin Psychiatry 2002;63 Suppl 12:10-15.
  7. Barkley RA. Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment. New York: Guilford Press;1990.
  8. Doyle AE. Executive functions in attention-deficit/hyperactivity disorder. J Clin Psychiatry 2006;67 Suppl 8:21-26.
  9. Barkley RA, Grodzinsky G, DuPaul GJ. Frontal lobe functions in attention deficit disorder with and without hyperactivity: a review and research report. J Abnorm Child Psychol 1992;20:163-188. https://doi.org/10.1007/BF00916547
  10. Goodyear P, Hynd GW. Attention-deficit disorder with (ADD/H) and without (ADD/WO) hyperactivity: behavioral and neuropsychological differentiation. J Clin Child Psychol 1992;21:273-305. https://doi.org/10.1207/s15374424jccp2103_9
  11. Barkley RA. Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull 1997;121:65-94. https://doi.org/10.1037/0033-2909.121.1.65
  12. Kuntsi J, Oosterlaan J, Stevenson J. Psychological mechanisms in hyperactivity: I. Response inhibition deficit, working memory impairment, delay aversion, or something else? J Child Psychol Psychiatry 2001;42:199-210. https://doi.org/10.1111/1469-7610.00711
  13. Rapport MD, Chung KM, Shore G, Denney CB, Isaacs P. Upgrading the science and technology of assessment and diagnosis: laboratory and clinic-based assessment of children with ADHD. J Clin Child Psychol 2000;29:555-568. https://doi.org/10.1207/S15374424JCCP2904_8
  14. Barkley RA. Attention-deficit/hyperactivity disorder. In: Mash EJ, Barkley RA, editors. Child psychopathology. 2nd ed. New York: Guilford Press;2003. p.75-143.
  15. Shin MS, Kim HM, On SG, Hwang JW, Kim BN, Cho SC. Comparison of executive function in children with ADHD, Asperger's disorder, and learning disorder. J Korean Acad Child Adolesc Psychiatry 2006;17:131-140.
  16. Denckla MB. Measurement of executive function. In: Lyon GR, editor. Frames of reference for the assessment of learning disabilities. New views on measurement issues. Baltimore: Brookers;1994. p.117-142.
  17. Smith EE, Jonides J. Storage and executive processes in the frontal lobes. Science 1999;283:1657-1661. https://doi.org/10.1126/science.283.5408.1657
  18. Baddeley A. Working memory, thought and action. New York: Oxford University Press;2007.
  19. Kofler MJ, Rapport MD, Bolden J, Altro TA. Working memory as a core deficit in ADHD: preliminary findings and implications. ADHD Rep 2008;16:8-14. https://doi.org/10.1521/adhd.2008.16.6.8
  20. Kim JH, Hong SD. Executive functions of attention deficit/ hyperactivity disorder. J Korean Acad Child Adolesc Psychiatry 1999;10: 15-20.
  21. Park S, Kim JY, Choi SH, Yoo HK, Hong JP, Kim SY, et al. A preliminary study of the efficacy and safety of bupropion as the second-line drug in children with attention deficit hyperactivity disorder. Korean J Psychopharmacol 2006;17:461-467.
  22. Shin JY, Yang JW, Jang WS, Hong SD. Prescription status and efficacy of OROS-MPH and parent perception in children with attention deficit hyperactivity disorder: multi-center, observational study during 4 weeks. Korean J Psychopharmacol 2007;18:50-59.
  23. Barkley RA. Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment. 2nd ed. New York: Guilford Press;1998.
  24. Pietrzak RH, Mollica CM, Maruff P, Snyder PJ. Cognitive effects of immediate-release methylphenidate in children with attention-deficit/hyperactivity disorder. Neurosci Biobehav Rev 2006;30:1225-1245. https://doi.org/10.1016/j.neubiorev.2006.10.002
  25. Riccio CA, Waldrop JJ, Reynolds CR, Lowe P. Effects of stimulants on the continuous performance test (CPT): implications for CPT use and interpretation. J Neuropsychiatry Clin Neurosci 2001;13: 326-335. https://doi.org/10.1176/jnp.13.3.326
  26. Yoo HK, Kim B, Joung YS, Bahn GH, Song DH, Ahn DH, et al. An open-label study of the improvements in clinical symptoms and neurocognitive functions in Korean children and adolescents with attention deficit hyperactivity disorder after treatment with metadate CD. J Korean Acad Child Adolesc Psychiatry 2011;22:253-261. https://doi.org/10.5765/jkacap.2011.22.4.253
  27. Pelham WE. Pharmacotherapy for children with attention-deficit hyperactivity disorder. School Psychol Rev 1993;22:199-227.
  28. Banaschewski T, Coghill D, Santosh P, Zuddas A, Asherson P, Buitelaar J, et al. Long-acting medications for the hyperkinetic disorders. A systematic review and European treatment guideline. Eur Child Adolesc Psychiatry 2006;15:476-495. https://doi.org/10.1007/s00787-006-0549-0
  29. Kim HL, Kim JW, Hong SB, Cho JH, Kim BN, Shin MS, et al. Effects of neurofeedback in children with attention deficit hyperactivity disorder: a preliminary study. J Korean Neuropsychiatr Assoc 2012;51:326-334. https://doi.org/10.4306/jknpa.2012.51.5.326
  30. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal treatment study of children with ADHD. Arch Gen Psychiatry 1999;56:1073-1086. https://doi.org/10.1001/archpsyc.56.12.1073
  31. Jensen PS, Arnold LE, Swanson JM, Vitiello B, Abikoff HB, Greenhill LL, et al. 3-year follow-up of the NIMH MTA study. J Am Acad Child Adolesc Psychiatry 2007;46:989-1002. https://doi.org/10.1097/CHI.0b013e3180686d48
  32. Molina BS, Hinshaw SP, Swanson JM, Arnold LE, Vitiello B, Jensen PS, et al. The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. J Am Acad Child Adolesc Psychiatry 2009;48:484-500. https://doi.org/10.1097/CHI.0b013e31819c23d0
  33. Schachar R, Herzog W, Leonard TR. Force enhancement above the initial isometric force on the descending limb of the force-length relationship. J Biomech 2002;35:1299-1306. https://doi.org/10.1016/S0021-9290(02)00188-4
  34. August GJ, Realmuto GM. Pharmacotherapy in ADHD. Guidelines for prescribing stimulant medications in young children. Minn Med 2000;83:45-46.
  35. Prince JB. Pharmacotherapy of attention-deficit hyperactivity disorder in children and adolescents: update on new stimulant preparations, atomoxetine, and novel treatments. Child Adolesc Psychiatr Clin N Am 2006;15:13-50. https://doi.org/10.1016/j.chc.2005.08.002
  36. Kim IH. Effect of the group art therapy in children with attention-deficit hyperactivity disorder(ADHD). J Korean Acad Psychiatr Mental Health Nurs 2006;15:152-160.
  37. Lee DH, Kim MS, Song YJ, Kwon BM. An exploratory review of literature on peer relationship of children with ADHD. Korean J Couns Psychother 2013;25:643-672.
  38. Park SH, Go H. A case study applying both cognitive behavioral therapy and art psychotherapy to an ADHD child. J Arts Psychother 2010;6:79-99.
  39. Abikoff H. An evaluation of cognitive behavior therapy for hyperactive children. Adv Clin Child Psychol 1987;10:171-216.
  40. Bugental DB, Collins S, Collins L, Chaney LA. Attributional and behavioral changes following two behavior management interventions with hyperactive boys: a follow-up study. Child Dev 1978;49: 247-250. https://doi.org/10.2307/1128619
  41. Gevensleben H, Holl B, Albrecht B, Vogel C, Schlamp D, Kratz O, et al. Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial. J Child Psychol Psychiatry 2009; 50:780-789. https://doi.org/10.1111/j.1469-7610.2008.02033.x
  42. Holtmann M, Sonuga-Barke E, Cortese S, Brandeis D. Neurofeedback for ADHD: a review of current evidence. Child Adolesc Psychiatr Clin N Am 2014;23:789-806. https://doi.org/10.1016/j.chc.2014.05.006
  43. Baydala L, Wikman E. The efficacy of neurofeedback in the management of children with attention deficit/hyperactivity disorder. Paediatr Child Health 2001;6:451-455. https://doi.org/10.1093/pch/6.7.451
  44. Lohaugen GC, Antonsen I, Haberg A, Gramstad A, Vik T, Brubakk AM, et al. Computerized working memory training improves function in adolescents born at extremely low birth weight. J Pediatr 2011;158:555-561.e4. https://doi.org/10.1016/j.jpeds.2010.09.060
  45. Thorell LB, Lindqvist S, Bergman Nutley S, Bohlin G, Klingberg T. Training and transfer effects of executive functions in preschool children. Dev Sci 2009;12:106-113. https://doi.org/10.1111/j.1467-7687.2008.00745.x
  46. Klingberg T. Training and plasticity of working memory. Trends Cogn Sci 2010;14:317-324. https://doi.org/10.1016/j.tics.2010.05.002
  47. Klingberg T, Fernell E, Olesen PJ, Johnson M, Gustafsson P, Dahlstrom K, et al. Computerized training of working memory in children with ADHD-a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 2005;44:177-186. https://doi.org/10.1097/00004583-200502000-00010
  48. Holmes J, Gathercole SE. Taking working memory training from the laboratory into schools. Educ Psychol (Lond) 2014;34:440-450. https://doi.org/10.1080/01443410.2013.797338
  49. Bergman-Nutley S, Klingberg T. Effect of working memory training on working memory, arithmetic and following instructions. Psychol Res 2014;78:869-877. https://doi.org/10.1007/s00426-014-0614-0
  50. Green CT, Long DL, Green D, Iosif AM, Dixon JF, Miller MR, et al. Will working memory training generalize to improve off-task behavior in children with attention-deficit/hyperactivity disorder? Neurotherapeutics 2012;9:639-648. https://doi.org/10.1007/s13311-012-0124-y
  51. Falth L, Jaensson L, Johansson K. Working memory training-a cogmed intervention. Int J Learn Teach Educ Res 2015;14:28-35.
  52. Egeland J, Aarlien AK, Saunes BK. Few effects of far transfer of working memory training in ADHD: a randomized controlled trial. PLoS One 2013;8:e75660. https://doi.org/10.1371/journal.pone.0075660
  53. Dunning DL, Holmes J, Gathercole SE. Does working memory training lead to generalized improvements in children with low working memory? A randomized controlled trial. Dev Sci 2013;16: 915-925.
  54. Olesen PJ, Westerberg H, Klingberg T. Increased prefrontal and parietal activity after training of working memory. Nat Neurosci 2004; 7:75-79. https://doi.org/10.1038/nn1165
  55. Korean Educational Development Institute. KEDI-WISC test manual. Seoul: Korean Educational Development Institute;1991.
  56. DuPaul GJ. Parent and teacher ratings of ADHD symptoms: psychometric properties in a community-based sample. J Clin Child Adoles Psychol 1991;20:245-253. https://doi.org/10.1207/s15374424jccp2003_3
  57. So YK, Noh JS, Kim YS, Ko SG, Koh YJ. The reliability and validity of Korean parent and teacher ADHD rating scale. J Korean Neuropsychiatr Assoc 2002;41:283-289.
  58. Haro JM, Kamath SA, Ochoa S, Novick D, Rele K, Fargas A, et al. The Clinical Global Impression-Schizophrenia Scale: a simple in strument to measure the diversity of symptoms present in schizophrenia. Acta Psychiatr Scand Suppl 2003;107:16-23. https://doi.org/10.1034/j.1600-0447.107.s416.5.x
  59. Lee JS, Kang SH, Park EH, Jung JS, Kim BN, Son JW, et al. Standardization of the comprehensive attention test for the Korean children and adolescents. J Korean Acad Child Adoles Psychiatry 2009;20:68-75.
  60. Bikic A, Leckman JF, Lindschou J, Christensen TO, Dalsgaard S. Cognitive computer training in children with attention deficit hyperactivity disorder (ADHD) versus no intervention: study protocol for a randomized controlled trial. Trials 2015;16:480. https://doi.org/10.1186/s13063-015-0975-8
  61. Beck SJ, Hanson CA, Puffenberger SS, Benninger KL, Benninger WB. A controlled trial of working memory training for children and adolescents with ADHD. J Clin Child Adolesc Psychol 2010;39:825-836. https://doi.org/10.1080/15374416.2010.517162
  62. van Dongen-Boomsma M, Vollebregt MA, Slaats-Willemse D, Buitelaar JK. [Efficacy of frequency-neurofeedback and Cogmed JMworking memory training in children with ADHD]. Tijdschr Psychiatr 2015;57:508-516.
  63. Bigorra A, Garolera M, Guijarro S, Hervas A. Long-term far-transfer effects of working memory training in children with ADHD: a randomized controlled trial. Eur Child Adolesc Psychiatry 2016;25:853-867. https://doi.org/10.1007/s00787-015-0804-3
  64. van Dongen-Boomsma M, Vollebregt MA, Buitelaar JK, Slaats-Willemse D. Working memory training in young children with ADHD: a randomized placebo-controlled trial. J Child Psychol Psychiatry 2014;55:886-896. https://doi.org/10.1111/jcpp.12218
  65. Hasher L, Zacks RT. Working memory, comprehension, and aging: a review and a new view. Psychol Learn Motiv 1988;22:193-225.
  66. Stevens MC, Gaynor A, Bessette KL, Pearlson GD. A preliminary study of the effects of working memory training on brain function. Brain Imaging Behav 2016;10:387-407. https://doi.org/10.1007/s11682-015-9416-2
  67. Holmes J, Gathercole SE, Dunning DL. Adaptive training leads to sustained enhancement of poor working memory in children. Dev Sci 2009;12:F9-F15. https://doi.org/10.1111/j.1467-7687.2009.00848.x
  68. Klingberg T, Forssberg H, Westerberg H. Training of working memory in children with ADHD. J Clin Exp Neuropsychol 2002;24:781-791. https://doi.org/10.1076/jcen.24.6.781.8395
  69. Kerns KA, Eso K, Thomson J. Investigation of a direct intervention for improving attention in young children with ADHD. Dev Neuropsychol 1999;16:273-295. https://doi.org/10.1207/S15326942DN1602_9

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