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"Attention Deficit Disorder with Hyperactivity therapy."
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The promoting effects of digital targeted cognitive training in medication treatment for children with ADHD: a randomized controlled trial
Background
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder often managed with medication. Improving cognitive functions alongside medication treatment is crucial for better outcomes. This study mainly aimed to investigate the therapeutic effects of combining digitally targeted cognitive training with medication compared to medication monotherapy on ADHD core symptoms. We hypothesized that targeted cognitive training could enhance treatment efficacy when combined with medication.
Methods
This was a randomized parallel-group controlled trial. A total of 124 children with ADHD were randomly allocated to two groups: 64 received medication treatment alone (M), including atomoxetine (ATX) and methylphenidate (MPH); 60 received targeted cognitive training combined with medication (TCT + M), including TCT + ATX and TCT + MPH. Both groups received 8 weeks of treatment. The primary outcome was the changes in ADHD core symptoms measured by the ADHD Rating Scale (ADHD-RS). The secondary outcomes were parent-reported ecological executive functions, social functions, and laboratory cognitive functions.
Results
Main results: When compared with M treatment, the TCT + M treatment did not show significant greater improvements in ADHD core symptoms, ecological executive functions, social functions, or laboratory cognitive functions. Post-hoc exploratory analysis results: (1) In patients who received ATX treatment, TCT + ATX led to greater improvement in ADHD-RS total, inattention, and hyperactivity/impulsivity symptoms. Similar between-group differences were observed in ecological executive functions, and the improvements were significantly correlated with changes of ADHD core symptoms. (2) In patients who received MPH treatment, no significant differences in the improvement of primary or secondary outcomes were observed between MPH monotherapy and TCT + MPH groups.
Conclusions
These findings demonstrated that, in comparison to medication monotherapy, the TCT + M treatment did not lead to more improvements in the core symptoms of ADHD, nor did it show superiority in other secondary outcomes. Specifically in children treated with atomoxetine, there’s a potential promoting effect of targeted cognitive training on medication treatment in terms of the alleviation of ADHD core symptoms.
Trial registration
This study was pre-registered with the Chinese Clinical Trial Registry under the identifier ChiCTR2100043525.
Journal Article
Cortical gyrification predicts initial treatment response in adults with ADHD
While the need for personalised treatment approaches grows in recognition, predicting treatment outcomes for adults with Attention-Deficit/Hyperactivity Disorder (ADHD) remains underexplored. Recent interest has turned to the brain’s surface and its association with treatment response. Although the precise interplay between cortical gyrification and ADHD treatment outcomes remains to be elucidated, preliminary investigations suggest a promising avenue for diagnostic innovation. Expanding upon the Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study (COMPAS), we investigated the prognostic value of cortical gyrification in predicting treatment response. Specifically, we explored how pre-treatment cortical gyrification might predict response to psychotherapy or clinical management in combination with either methylphenidate or placebo following a 12-week intensive treatment period. Cortical gyrification was assessed using 121 T1-weighted anatomical scans. Linear regression models investigated the predictive value of cortical gyrification, regressing baseline cortical structure against post-treatment severity. All brain structural analyses were conducted using the threshold-free cluster enhancement (TFCE) approach and the Computational Anatomy Toolbox (CAT12) within the Statistical Parametric Mapping Software (Matlab Version R2021a). Results revealed significant positive region-specific associations between cortical gyrification and treatment response across three symptom dimensions, with significant associations localised predominantly in frontal regions of the left hemisphere. Our findings emphasise that increased cortical gyrification in frontal cortical regions signifies enhanced treatment efficacy following a 12-week intervention. Further research in this area is imperative to verify the reliability of biological markers in view of treatment success to potentially reduce unnecessary drug-related side-effects, minimising delay from receiving more effective treatments, and increase treatment adherence.
Journal Article
Short-term effects of an elimination diet and healthy diet in children with attention-deficit/hyperactivity disorder: a randomized-controlled trial
An Elimination Diet (ED) may be effective in reducing symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), but has never been compared to an active control condition [i.e., Healthy Diet (HD)]. In a two-armed RCT, a total of N = 165 children (5–12 years) with ADHD were randomized by means of minimization (1:1) to either an ED (N = 84) or HD (N = 81) within two Dutch child and adolescent psychiatry centers. The design included a non-randomized comparator arm including N = 58 children being treated with Care as Usual (CAU). Treatment allocation was unblinded. The primary outcome was a 5-point ordinal measure of respondership based on a combination of parent and teacher ratings on ADHD and emotion regulation, determined after 5 weeks of treatment. Ordinal regression analyses were done on an intention-to-treat basis. Fewer ED (35%) than HD (51%) participants showed a partial to full response, despite overall good-to-excellent treatment adherence (> 88%) and comparable high parental prior believes. A younger age and higher problem severity predicted a better respondership. CAU-preferring participants responded more often favorably (56%) compared to ED—but not HD—participants. Small-to-medium improvements in physical health (blood pressure, heart rate, and somatic complaints) were found in response to ED/HD versus decrements in response to CAU (74% received psychostimulants). The lack of superiority of the ED versus HD suggests that for the majority of children, dietary treatment response is not rooted in food-allergies/-sensitivities. The comparable results for treatment with HD and CAU are remarkable given that CAU participants were probably ‘easier to treat’ than HD (and ED) participants with proportionally fewer with a (suboptimal/non-response to) prior treatment with medication (4% versus 20%). Further assessment of long-term effects is needed to evaluate the potential place of dietary treatment within clinical guidelines. The trial is closed and registered in the Dutch trial registry, number NL5324 (https://www.onderzoekmetmensen.nl/en/trial/25997).
Journal Article
Treatment strategies for ADHD: an evidence-based guide to select optimal treatment
Attention-deficit/hyperactivity disorder (ADHD) is a common and impairing disorder affecting children, adolescents, and adults. Several treatment strategies are available that can successfully ameliorate symptoms, ranging from pharmacological to dietary interventions. Due to the increasing range of available options, an informed selection or prioritization of treatments is becoming harder for clinicians. This review aims to provide an evidence-based appraisal of the literature on ADHD treatment, supplemented by expert opinion on plausibility. We outline proposed mechanisms of action of established pharmacologic and non-pharmacologic treatments, and we review targets of novel treatments. The most relevant evidence supporting efficacy and safety of each treatment strategy is discussed. We review the individualized features of the patient that should guide the selection of treatments in a shared decision-making continuum. We provide guidance for optimizing initiation of treatment and follow-up of patients in clinical settings.
Journal Article
Developmental processes in peer problems of children with attention-deficit/hyperactivity disorder in The Multimodal Treatment Study of Children With ADHD: Developmental cascades and vicious cycles
We examined the developmental processes involved in peer problems among children (M age = 10.41 years) previously diagnosed with attention-deficit/hyperactivity disorder (ADHD) at study entry (N = 536) and a comparison group (N = 284). Participants were followed over a 6-year period ranging from middle childhood to adolescence. At four assessment periods, measures of aggression, social skills, positive illusory biases (in the social and behavioral domains), and peer rejection were assessed. Results indicated that children from the ADHD group exhibited difficulties in each of these areas at the first assessment. Moreover, there were vicious cycles among problems over time. For example, peer rejection was related to impaired social skills, which in turn predicted later peer rejection. Problems also tended to spill over into other areas, which in turn compromised functioning in additional areas across development, leading to cascading effects over time. The findings held even when controlling for age and were similar for males and females, the ADHD and comparison groups, and among ADHD treatment groups. The results suggest that the peer problems among children with and without ADHD may reflect similar processes; however, children with ADHD exhibit greater difficulties negotiating important developmental tasks. Implications for interventions are discussed.
Journal Article